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The Moir Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 3 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Moir Medical Practice on 27 August 2015. A breach of legal requirements was found in that formal systems were not in place, to assess and control all risks associated with the premises. Overall the practice was rated as good with requires improvement for the safe domain.

After the comprehensive inspection, the practice wrote to us to say what action they had, and were taking to meet the legal requirement in relation to the breach.

We undertook this desk based review on 15 July 2016 to check that the provider had completed the required actions, and now met the legal requirements. We did not visit the practice as part of this inspection. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Moir Medical Practice on our website at www.cqc.org.uk.

Our finding across the area we inspected was as follows:

The practice had taken appropriate action to meet the legal requirement. 

Overall the practice is rated good including the safe domain.

Formal systems were in place to assess, monitor and minimise all risks associated with the premises, to ensure the services were safe.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 August 2016

The practice is rated as good for providing safe services.

  • Formal systems were in place to assess, monitor and manage all risks associated with the premises to ensure the services were safe.

  • A legionella risk assessment of Moir Medical Centre and the Toton branch surgery was completed in January 2016. An action plan and control measures were in place to eliminate and manage the risks identified in the assessment.
  • The branch surgery at Sawley was newly built in 2014. To comply with health and safety regulations a risk assessment was completed, and control measures were put in place to minimise the risk of exposure to legionella. 
  • The health and safety policy had been updated to assess further risks associated with the premises, including manual handling and slips and trips. Appropriate measures had been taken to control and eliminate the risks identified in the assessment at all three surgeries.

Effective

Good

Updated 24 December 2015

The practice is rated as good for providing effective services. Information we reviewed showed that outcomes for patients were in line with the locality. Staff had access to local and national guidelines and used these routinely to plan and deliver patient care.

Staff had received relevant role specific training and further training was planned as required.

We saw evidence of effective multidisciplinary working with external organisations. For example, the practice worked closely with a care coordinator to ensure their patients had the appropriate care in place following discharge from hospital.

We saw evidence that the practice was using clinical audit to drive improvements. For example, the practice had audited the prescribing of a specific medication to a high risk group and changed its practice. A repeat audit showed that no patients within the high risk group were being prescribed the medication.  

Caring

Good

Updated 24 December 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care. For example, 91% said the GP was good at listening to them compared to the CCG average of 88% and national average of 89%.

Most patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

The practice provided a range of information about services which was easy to understand and accessible. We observed that staff treated patients with kindness and respect.

Responsive

Good

Updated 24 December 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice had recently opened a new branch practice in Sawley to provide a more localised service.

Patient survey data indicated that patients experienced difficulties in accessing appointments, especially with a named GP. However, the practice was aware of patient concerns in relation to access and was working with their patient participation group (PPG) to address these concerns. The practice had implemented suggestions such as putting doctor’s rotas on the website. 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 that the practice responded quickly to issues raised. Learning from complaints was shared widely.

Well-led

Good

Updated 24 December 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. 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. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active and met regularly with the practice to share ideas for improvement. Staff had received inductions, regular performance reviews and attended staff meetings and events. Staff were encouraged to make suggestions for improvements within the practice, including how the practice could deliver improved patient care. For example, the healthcare assistant had undertaken a review of NHS health checks and drafted proposals as to how these could be improved.

Checks on specific services

People with long term conditions

Good

Updated 24 December 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. We saw evidence that the practice had worked to improve the care it delivered in respect of long term conditions, for example data showed that the practice had improved its performance in respect of monitoring of people with high blood pressure.

Families, children and young people

Good

Updated 24 December 2015

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 at risk, for example, children and young people who had a high number of A&E attendances. Staff were able to give examples of how they liaised with the health visiting team if they had concerns about a child. Immunisation rates were relatively high for all standard childhood immunisations and the practice performed particularly well for immunisations at 5 years. Premises were suitable for children and babies, having access for pushchairs and baby changing facilities. We saw good examples of joint working with midwives, health visitors and school nurses including joint meetings.

Older people

Good

Updated 24 December 2015

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

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. For example, the practice provided data to show people with osteoporosis were treated appropriately. The practice offered enhanced services to meet the needs of its older population, for example, for patients living with dementia or those requiring end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments as required. The practice had increased its presence in local care homes and was in the process of initiating a regular visiting schedule to try to minimise requests for home visits.

Working age people (including those recently retired and students)

Good

Updated 24 December 2015

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. For example, the practice opened until 9.00pm on a Tuesday evening for pre-booked appointments. The practice was proactive in offering online services as well as a full range of health promotion information that reflected the needs of this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the management of people experiencing poor mental health, including those with dementia. It carried out advanced care planning for patients with dementia. The practice had worked to improve its systems for the review of patients with dementia. For example, the practice had instigated a regular review of care home patients by a nurse practitioner.

The practice had told patients experiencing poor mental health about how to access appropriate support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Multidisciplinary meetings were attended by the community psychiatric nurse.

People whose circumstances may make them vulnerable

Good

Updated 24 December 2015

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

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice worked closely with the care coordinator to ensure that the needs of vulnerable patients were well managed in the community. Patients who had been discharged from hospital were reviewed by the care coordinator to consider how any future admissions might be avoided. The care coordinator also ensured that patients’ needs were being met. The care coordinator and practice staff signposted vulnerable patients to appropriate support groups and voluntary organisations. This information was also available in the practice waiting area.

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.