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The Borchardt Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 2 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Borchardt Medical Centre, 62 Whitchurch Road, Withington, Manchester, M20 1EB on 16 December 2015. During the inspection we identified breaches of regulation 12 (Safe Care and Treatment), regulation 17 (Good governance) and regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches resulted in the practice being rated as requires improvement for being safe and well-led and good for being effective, caring and responsive. Consequently the practice was rated as requires improvement overall.

The specific concerns identified were:

  • The risk assessments associated with the environment were not available to view on the day of inspection. Systems to maintain emergency equipment had not been followed and emergency equipment was found to be out of date.

  • Systems and processes were not in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients. Staff training was not managed in such a way as to ensure appropriate training and professional development was carried out to enable them to carry out the duties they were employed to perform. Some policies and procedures were found to be out of date and did not reflect current practice.

  • The provider had not followed recruitment procedures to establish all information specified in Schedule 3 was available in respect of all staff employed to ensure staff are safely and effectively recruited and employed.

An announced comprehensive inspection was carried out at on 27 March 2017. This report reflects the action that the practice has taken to address the concerns identified during our initial inspection.

Overall the practice is now rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Urgent appointments were usually available on the day they were requested. However, patients did report difficulties booking appointments by telephone.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice was a member of the South Manchester GP Federation (SMGPF) a group of 24 GP practices working in partnership to improve patient access to health care.
  • The practice worked closely with the nursing home team. This team of nurses carried out health reviews and provided advice on the management of acute and long term conditions for nursing home residents with the aim of reducing unnecessary admission to hospital. This was achieved by enabling nursing home residents to access a range of community services.
  • The diabetes specialist nurse supported newly diagnosed patients and offered insulin initiation as required, which made this easier to access for patients.
  • The practice was involved with the co-production of services via Royal College of General Practitioners (RCGP) Future Hospital Scheme.

We saw an area of outstanding practice:

The GPs recognised that many patients attending the practice had non-medical conditions. In October 2015 the practice began a trial period of the social prescribing initiative in partnership with Southway Housing Trust to improve support for patient wellbeing. Social prescribing is a non-medical intervention used to support people to improve their health and wellbeing with referrals to community support services.

The practice was able to provide details of how this service had positively impacted on the health and wellbeing of the patients they had referred. As a result of the success of this venture social prescribing had been rolled out to other practices in the neighbourhood.

The areas where the provider should make improvements:

  • Continue to make efforts to encourage the development of a patient participation group.
  • Continue to identify and register those patients who were also carer’s.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 May 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 2 May 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice provided appropriate support for end of life care and patients and their carers received good emotional support.


Caring

Good

Updated 2 May 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 2 May 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 2 May 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 2 May 2017

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • 76% of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2015 to 31/03/2016) which was comparable to the CCG and national average of 78% and 78% respectively.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice worked in partnership with the North West Lung unit in the care and treatment of patients diagnosed with chronic obstructive pulmonary disease (COPD). This included multi-disciplinary virtual clinics where patient care was discussed and treatment plans agreed. The clinics were led by a specialist thoracic consultant.
  • The practice provided a level 9 drug service and held a weekly drug clinic with referrals accepted from other GP practices and the local authority.

Families, children and young people

Good

Updated 2 May 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • 94% of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2015 to 31/03/2016) which was better than the CCG and national average of 82% and 81% respectively.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 2 May 2017

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had monthly multidisciplinary meetings with social workers, mental health workers and district nurses to discuss at risk patients and used a rapid response service to keep people at home avoiding a hospital admission where possible.

Working age people (including those recently retired and students)

Good

Updated 2 May 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • GP extended access appointments were available to patients who were unable to access appointments during normal surgery hours, due to work or other commitments or when the practices appointments are fully booked. Extended access appointments were available at three sites across south Manchester.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 May 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • 93% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG and national average of 86% and 83% respectively.
  • 95% of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months (01/04/2015 to 31/03/2016) which was comparable with the CCG and national average of 87% and 89% respectively.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 2 May 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.