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Stillmoor House Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Stillmoor House Medical Practice on 5 January 2016. This was to review the actions taken by the provider as a result of our issuing two legal requirements.

Overall the practice has been rated as GOOD following our findings.

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

  • The provider had protected patients against the risks associated with unsafe use and management of medicines by means of making the appropriate arrangements for the safe keeping of medicines. This included the servicing of refrigerators used to store medicines, calibration of thermometers and use of additional digital thermometers to record internal temperatures for continued monitoring.

  • Effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others had been implemented. These included the involvement of relevant staff in the discussion and learning from significant event analysis. Records showed subsequent actions were taken and how or with whom any learning was shared.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 February 2016

The practice is now rated as good for safe having improved systems and processes to reduce safety risks.

  • Patients were protected against the risks associated with unsafe use and management of medicines by means of making the appropriate arrangements for the safe keeping of medicines. This included the introduction of servicing of refrigerators used to store medicines, calibration of thermometers and use of additional digital thermometers to record internal temperatures for continued monitoring.

  • Effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others had been implemented. These included the analysis of significant events and involvement of relevant staff in the discussion and learning from these. Records showed subsequent actions were taken and how or with whom any learning was shared.

Our findings at the last inspection were that alerts were brought to the attention of staff appropriately so they could check and adjust their work accordingly. Good systems were in place to maintain a clean and hygienic service. Risks to patients were assessed and well managed. There were enough staff to keep patients safe. The practice had management systems for safeguarding and review risks to children, young people and vulnerable adults.

Effective

Good

Updated 4 February 2016

Caring

Good

Updated 4 February 2016

Responsive

Good

Updated 4 February 2016

Well-led

Good

Updated 4 February 2016

Checks on specific services

People with long term conditions

Good

Updated 13 August 2015

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

There was a system in place to review medication for patients with multiple conditions. Longer appointment times were given for these reviews to ensure a ‘one-stop’ approach.

Over 90% of patients with diabetes, COPD, or coronary heart disease had a minimum of an annual review with a specific health care professional. As part of the review the practice routinely discussed anxiety and mood. GPs and nurses had training to support their lead roles in providing care for specific disease areas.

In the previous year, 80% of asthmatic patients had a full review of their symptoms and medication. Where necessary home visits were provided with practice nurses providing care and support.

The practice met fortnightly with the palliative care team including the Macmillan nurse and community nurse to discuss patients under their care.

The practice held a register of patients with raised blood glucose levels and recalled these patients for regular monitoring. Patients were offered lifestyle advice with respect to prevention of diabetes and if appropriate were referred to a weight management service. The practice carried out health checks for patients aged 40-74 years, calculating their risk for developing diabetes, heart disease etc. and measuring cholesterol levels.

Patients within this group who were at high risk of hospital admission were included in the practice admission avoidance plan. Each had a care plan in place with GP and community matron input as appropriate.

Families, children and young people

Good

Updated 13 August 2015

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

The practice had a system in place to identify and follow-up children at risk, with a GP holding bi-monthly meetings with the health visitor team to look at families in this group.

The practice achieved over 95% success for childhood vaccination, and patients who failed to attend were contacted by the practice.

The midwife attended the practice and held an ante-natal clinic each Wednesday afternoon. She entered patient information into the practice clinical system, which aided continuity of care during pregnancy.

A&E letters were reviewed routinely by the safeguarding lead for children and young people to screen for any safeguarding concerns.

The practice offered appointments outside of school hours, but also had evening and alternate Saturday morning surgery to allow routine access to GP and nurses at convenient times for parents and children.

The practice operated a college based service in the town offering lunchtime appointments to pupils aged 13-19 years at the college. These appointments were with a GP or practice nurse and offered counselling, contraception, lifestyle advice, as well as routine medical care. Patients did not have to be registered with the practice to use this service. The drop in clinic was provided by this practice two days per week, and by another surgery in the town on another two days. Staff told us the patients were presenting mainly with mental health issues and contraception. We observed that good quality assessments had been made of patients’ mental health needs and a responsive service was provided. Staff were using the principles of the Gillick judgements to assess young patients’ ability to give informed consent. Some young patients also came to the surgery during school time, and they would be given an appropriate appointment even if not registered with this practice.

The practice was EEFO registered (Cornwall Council) as a service which offers supportive and confidential advice to under 18’s. EEFO kite marks services that meet young person friendly quality standards across Cornwall and the Isles of Scilly. The term EEFO is not an abbreviation. EEFO is a word that has been designed by young people, to be owned by young people.

Older people

Good

Updated 13 August 2015

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

The practice held a register of all patients aged 75 and over and provided these patients with details of their named GP. Patients at risk of an unplanned admission had a personal care plan which had been reviewed by the GP and/or the community matron.

Housebound patients were offered home visits which included a review of any chronic disease they had including diabetes, COPD or coronary heart disease. The practice provided urgent telephone access to a GP on the same day for patients to discuss urgent medical concerns and this allowed older patients easy access to medical advice when needed.

The practice worked as part of a multi-disciplinary team for older patients, comprising community nurses, the practice nursing team, Macmillan nurse, and social worker to provide additional support, ensure that medical care was co-ordinated, and ensure patients were well cared for in the community.

When patients were discharged from hospital, the GP or practice manager phoned them to ensure patients on-going needs were met.

Working age people (including those recently retired and students)

Good

Updated 13 August 2015

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

The practice is open from 8am to 6pm every day with telephone access until 6.30pm. Extended hours appointments with both GPs and practice nurses were available on alternate Wednesday and Thursday evenings until 8pm as well as Saturday appointments on alternate weeks.

The practice offered same-day access to speak to a GP and patients could specify a convenient time for a call back to suit their needs. If necessary, after speaking with the GP, they could be offered a suitable appointment for their health care needs.

Patients could apply on-line for appointments, as well as on-line ordering for repeat medication. There was a telephone answering service for repeat medication. The patients could nominate a pharmacy where they wanted to collect their prescription avoiding a separate journey to the surgery.

The practice offered health promotion through a dedicated stop-smoking clinic, via telephone or by appointment with a smoking adviser. Patients could be referred to weight management programmes and exercise programmes through local council providers at introductory reduced rates.

Health checks were offered to patients aged 40-74 years at which their risk for developing diabetes and heart disease were assessed. Patients were advised of this service by a letter of invitation.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 August 2015

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

The practice held a monthly mental health ‘HUB’ meeting where representatives from all aspects of the mental health team attended. This included clinical psychiatrists, community mental health nurses, and staff from a counselling service, local day centre, employment and training support, and the dementia support team. These meetings allow for multidisciplinary review of patients with poor mental health and signposted access to services and support for patients.

The practice participated in in the Dementia Screening scheme as a directed enhanced service. Patients identified in accordance with NICE guidelines received active screening as part of their chronic disease reviews and access to memory clinic services was arranged when appropriate. Follow-up by a consultant psychiatrist was arranged for newly diagnosed dementia patients.

Patients with mental health concerns were offered an annual review including a review of their physical health. Over 90% of patients had received a health check, and over 50% of patients had a care plan in place. GPs said they had a high number of patients with a diagnosed mental health issue due to a mental health hospital in the area having been closed. The former inpatients did not have active mental health issues and were happy to have screening but not keen to have a care plan and so did not turn up for appointments. For this year they had introduced a comprehensive new template and the care plan was drawn up at the medication review. There were 130 patients with severe and enduring mental illness on the register.

The practice provided primary care for patients living in a nursing home for older people with mental health problems. They also provided support for patients in community hospital beds under the care of a local psychiatrist.

The local community team had instigated a ‘Single Point of Access’ for all referrals of patients with mental health problems including access to urgent care on the day using e-mail to the duty community psychiatric nurse team for assessment. The practice found this was a useful system for obtaining good outcomes for patients. Communication between GPs and community psychiatric nurses (CPN) or the consultant or staff grade psychiatrist was enhanced due to some GPs regularly working at the psychiatric hospital. This was useful when a formal approach was not necessary, for example, to check their care management plan was appropriate for the patient’s needs.

People whose circumstances may make them vulnerable

Good

Updated 13 August 2015

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

The practice held a register for patients with learning disabilities, and offered an annual extended appointment with an appropriately trained nurse to review their health and social care needs. The nurse lead worked closed with the community based learning disability nurse and visited housebound patients at their home address. Comprehensive health plans were produced and placed in the patients’ electronic records.

Staff had received training to enable them to recognise signs of abuse for children and vulnerable adults and were aware of their responsibilities with respect to sharing information and reporting concerns. The practice safeguarding lead and their deputy were available for staff to discuss any issues raised.

The practice had close working relations with the St Petroc’s Society who provide accommodation for homeless people in the area. The practice registered patients at the home’s request. When a homeless patient presented at the practice they were given an emergency appointment and did not need to provide a telephone number for triage call-back. These patients were able to use the practice address as a 'care of' address for hospital appointments.

The practice was registered under the local Cornwall Council ‘safe places’ scheme and offered a safe place for vulnerable people. Patients coming to the practice under this scheme presented a card then the practice contacted their next of kin or chosen primary contact to keep them safe.

National data showed the practice performing well in maintaining registers of patients with learning disabilities.