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Hilltops Medical Centre Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 12 November 2019

We carried out an announced inspection at Hilltops Medical Centre on 15 October 2019 as part of our inspection programme. We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

  • Safe
  • Effective
  • Well-led

At the last inspection in November 2018 we rated the practice as good overall and requires improvement for providing safe services because:

  • Risks to patients and staff had not adequately been assessed and monitored, in particular with regard to infection prevention and control and blank prescription stationery security.
  • The practice did not evidence a consistent approach to recruitment through the provision of appropriate recruitment records.

At this inspection, we found that the provider had taken some action to improve in these areas. In particular, concerns with blank prescription stationery security had been resolved.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall and good for all population groups. The practice was rated as requires improvement for providing safe and well-led services.

We found that:

  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs.
  • The way the practice was clinically led and managed promoted the delivery of high-quality, person-centre care.
  • There was a clear leadership structure. However, support for effective practice management was lacking. The practice proactively sought feedback from staff and patients, which it acted on.
  • There was evidence of continuous learning and improvement at all levels of the organisation.

We rated the practice as requires improvement for providing safe services because:

  • Systems and processes to reduce risks to patient and staff safety needed strengthening.
  • Risks to patients and staff had not adequately been assessed, in particular those relating to staff immunity status, infection prevention and control, appropriate background checks for staff, significant events and safety alerts.

We rated the practice as requires improvement for providing safe services because:

  • Systems and processes to reduce risks to patient and staff safety were lacking.
  • There was limited evidence of improvements made following our inspection in November 2018.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Undertake risk assessments for any storage of hazardous substances for example, liquid nitrogen, storage of chemicals.
  • Ensure all policies, procedures and protocols are regularly reviewed and appropriate for implementation.
  • Maintain accurate recruitment records in line with practice policy and legislative requirements.
  • Complete timely appraisals for all staff.
  • Improve the support and implementation of practice managerial functions.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas

Safe

Requires improvement

Caring

Good

Updated 10 January 2019

We rated the practice as good for caring.

Kindness, respect and compassion

Staff treated patients with kindness, respect and compassion.

  • Feedback from patients was positive about the way staff treat people.
  • Staff understood patients’ personal, cultural, social and religious needs.
  • The practice gave patients timely support and information.
  • The practices GP patient survey results were below local and national averages for some questions relating to kindness, respect and compassion. In particular:

  • The percentage of respondents to the GP patient survey who stated that the last time they had a general practice appointment, the healthcare professional was good or very good at treating them with care and concern was 75% compared to the local average of 82% and the national average of 87%.
  • The percentage of respondents to the GP patient survey who stated that during their last GP appointment they had confidence and trust in the healthcare professional they saw or spoke to was 89% compared to the local average of 93% and the national average of 96%.
  • The percentage of respondents to the GP patient survey who responded positively to the overall experience of their GP practice was 63% compared to the local average of 77% and the national average of 84%.

The practice was aware of the lower than average performance in some areas of the most recent national GP patient survey. The practice ascertained this to the period of change and disruption that had occurred over the preceding 12 months. The practice had been unsuccessful in its attempts to recruit GPs for two years. Patients we spoke with were positive in their comments when referring to their experience of consultations and the attitude of practice staff. The practice was able to evidence patient satisfaction was considered and actions were taken in an effort to improve patient satisfaction where possible.

Involvement in decisions about care and treatment

Staff helped patients to be involved in decisions about care and treatment. They were aware of the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information that they are given.)

  • Staff communicated with people in a way that they could understand, for example, communication aids and easy read materials were available if requested.
  • Staff helped patients and their carers find further information and access community and advocacy services. They helped them ask questions about their care and treatment.
  • The practice proactively identified carers and supported them.
  • The practices GP patient survey results were in line with local and national averages for questions relating to involvement in decisions about care and treatment.

Privacy and dignity

The practice respected patients’ privacy and dignity.

  • When patients wanted to discuss sensitive issues, or appeared distressed reception staff offered them a private room to discuss their needs.
  • Staff recognised the importance of people’s dignity and respect. They challenged behaviour that fell short of this.

Please refer to the evidence tables for further information

Responsive

Good

Updated 10 January 2019

We rated the practice, and all of the population groups, as good for providing responsive services

.

Responding to and meeting people’s needs

The practice organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

  • The practice understood the needs of its population and tailored services in response to those needs.
  • Telephone GP consultations were available which supported patients who were unable to attend the practice during normal working hours.
  • The facilities and premises were appropriate for the services delivered.
  • The practice made reasonable adjustments when patients found it hard to access services.
  • The practice provided effective care coordination for patients who are more vulnerable or who have complex needs. They supported them to access services both within and outside the practice.
  • Care and treatment for patients with multiple long-term conditions and patients approaching the end of life was coordinated with other services.

Older people:

  • All patients had a named GP who supported them in whatever setting they lived, whether it was at home or in a care home or supported living scheme.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice supported patients living in a local nursing home. GPs undertook twice weekly visits in an effort to avoid hospital admissions. The practice pharmacist undertook weekly visits to the nursing home to review patient medications.

People with long-term conditions:

  • Patients with a long-term condition received an annual review to check their health and medicines needs were being appropriately met. Multiple conditions were reviewed at one appointment, and consultation times were flexible to meet each patient’s specific needs.
  • The practice held regular meetings with the local district nursing team to discuss and manage the needs of patients with complex medical issues.
  • The practice nursing team provided leg ulcer and Doppler services.
  • The practice had a facility to enable self-checking of patients’ blood pressure

Families, children and young people:

  • We found there were systems 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 accident and emergency (A&E) attendances. Records we looked at confirmed this.
  • All parents or guardians calling with concerns about a child under the age of 18 were offered a same day appointment when necessary. When the practice was unable to provide urgent appointments for children, patients could be seen at the Primary Care Centre located within the hospital. The service was organised by the local GP Federation, of which the practice was a member and ensured that children from across the locality received same day urgent appointments when their own GP practice was unable to facilitate an appointment.

Working age people (including those recently retired and students):

  • The needs of this population group 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, extended opening hours and Saturday appointments.
  • The practice was investing in a new website to enable extensive online services and to improve access for patients unable to telephone or attend the practice during normal working hours.
  • The practice had signed up to the Electronic Prescribing Service (EPS), enabling patients to collect their prescriptions from a pharmacy of choice.
  • The practice also used utilised a two-way text messaging service (Mjog) to improve digital communications with patients.

People whose circumstances make them vulnerable:

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • People in vulnerable circumstances were easily able to register with the practice, including those with no fixed abode.
  • The practice supported neurologically disabled patients in two local nursing homes. GPs provided twice weekly visits to improve care for these patients.
  • The practice supported patients with learning disabilities living in two local residential homes.
  • The practice supported patients on criminal probation living in a local residential service as they were reintroduced back into society.
  • The practice facilitated the local Citizens Advice Bureau weekly, enabling patients to seek non-clinical advice in a local setting.
  • At the time of our inspection the practice was working alongside the British Red Cross to support 284 asylum seekers, refugees, refused asylum seekers and economic migrants.

People experiencing poor mental health (including people with dementia):

  • Staff interviewed had a good understanding of how to support patients with mental health needs and those patients living with dementia.
  • The practice recognised local challenges in accessing mental health services and was partaking in a locality pilot scheme to improve access to services. Through this pilot scheme the practice facilitated the local mental health team once a week to see patients. The pilot was expected to last six months.

Timely access to care and treatment

We reviewed whether patients were able to access care and treatment from the practice within an acceptable timescale for their needs.

  • Patients had timely access to initial assessment, test results, diagnosis and treatment.
  • The practice was making continued efforts to reduce waiting times, delays and cancellations.
  • Patients with the most urgent needs had their care and treatment prioritised.
  • Patients we spoke with reported difficulties with the appointment system, with appointment availability not meeting demand on a daily basis.
  • Although the practices GP patient survey results were in line with local and national averages for questions relating to access to care and treatment, the practice advised that patients had expressed increased dissatisfaction with appointment access. We saw the practice was taking a proactive approach to improvement. For example, through the recruitment and ongoing training of a diverse clinical team to improve accessibility for patients. This included the recruitment of two advanced nurse practitioners, a paramedic and a physiotherapist. The practice pharmacist had also been supported to qualify as a prescriber. The practice advised that the newly recruited team would all be in situ from January 2019 and they anticipated improved access and satisfaction to follow.

Listening and learning from concerns and complaints

The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.

  • Information about how to make a complaint or raise concerns was available on the practice website. However, on the day of inspection there was no information in the patient waiting area to advise patients on how to make a complaint. Following our inspection, the practice advised a message had been placed on the information screen in the waiting area to advise patients of the complaints procedure.
  • Staff treated patients who made complaints compassionately.
  • The complaint policy and procedures were in line with recognised guidance. The practice learned lessons from individual concerns and complaints and also from analysis of trends. It acted as a result to improve the quality of care.

Please refer to the evidence tables for further information.

Well-led

Requires improvement
Checks on specific services

People with long term conditions

Good

Families, children and young people

Good

Working age people (including those recently retired and students)

Good

People experiencing poor mental health (including people with dementia)

Good

People whose circumstances may make them vulnerable

Good