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Henfield Medical Centre Good Also known as Henfield Medical Practice

Inspection Summary


Overall summary & rating

Good

Updated 3 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Henfield Medical Centre on 6 October 2016. The overall rating for the practice was good but was rated as requires improvement for providing safe services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Henfield Medical Centre on our website at www.cqc.org.uk.

Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:

  • Ensuring the safe and proper management of medicines are reviewed to protect patients against the risk of unsafe care and treatment.

  • Ensuring that the assessment, detection and controlling the spread of infections, including those that are associated with health care are reviewed so that their infection control audit procedure has a method of documenting how issues are resolved and when this was done.

Additionally we had found that:

  • The practice needed to review their complaints process to ensure patients are given information on how they can escalate a complaint should they remain dissatisfied.

  • The practice needed to record and ensure that the reasons for fridge temperatures going out of range was established.

This inspection was an announced focused inspection carried out on 4 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is still rated as good.

Our key findings were as follows:

  • The provider had reviewed all aspects of medicines management and devised new standard operating procedures which all appropriate staff had been notified of and signed to acknowledge the information within these.

  • The provider had reviewed their infection control audit process and now documented how issues were to be resolved and when these were to be completed by.

  • The provider had reviewed their complaints procedure and now ensured that information was provided to the complainant that allowed them to escalate a complaint should they remain dissatisfied.
  • The provider had reviewed how they recorded their fridge temperatures and documented the cause when temperatures went outside the accepted range and undertook appropriate actions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 May 2017

At our previous inspection on 6 October 2016, we rated the practice as requires improvement for providing safe services as the arrangements in respect of infection control management and medicines management required some improvements.

On our inspection of 4 April 2017 we found that:

  • We saw evidence that medicine management practices were comprehensive and kept patients safe.
  • The practice now documented actions taken to resolve issues found during infection control audits and also recorded when these were completed.
  • The practice now documented the reason that fridges went outside their accepted temperature range and recorded the actions taken to remedy this.

Effective

Good

Updated 7 December 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.
  • Data showed that the practice was performing highly when compared to practices nationally. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 85% compared to the local clinical commissioning group (CCG) average of 80% and the national average of 78%.
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.
  • The practice operated a “same day team” consisting of a duty GP, triage nurse and duty administrative staff. This team met mid-morning to discuss and assess the priority of their home visit requests. This team also managed all urgent appointments.
  • All GPs had a personal list of patients to allow for continuity of care.

Caring

Good

Updated 7 December 2016

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 7 December 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. This included close working relationships with the pro-active care team to reduce unplanned admissions.
  • The practice formed a partnership with patients in managing their long term conditions with the use of patient passports which held important information and test information for individual patients.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example there were now more telephone consultations available for patients.
  • Patients can access appointments and services in a way and at a time that suits them. Patients also had access to their individual GPs personal assistant to enable them to raise any concerns via them to which they then respond appropriately.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice provided a drop-in clinic every Wednesday afternoon for young patients between 4pm and 4.30pm.
  • The practice was awarded a PACE Setter award in 2016 for their work in attempting to reduce teenage pregnancy.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders. However, the practice did not inform patients how they could escalate the complaint should they still remain dissatisfied following the final response letter.

Well-led

Good

Updated 7 December 2016

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. The patient participation group was active.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 7 December 2016

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.
  • Data from 2014/15 showed The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 94% compared to the CCG average of 91% and a national average of 88%.
  • 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 had a system called “passport to health” which was a personalised care management plan that was agreed in partnership with the patient and gave details of when blood tests and other reviews were required.
  • The practice undertook monthly diabetic review clinics led by a practice nurse who had a diploma in diabetic care and supported by a specialist diabetic community nurse.
  • The practice undertook quarterly meetings with community and hospice nurses.
  • The practice had organised two fitness “boot camps” lasting six weeks each at the local leisure centre for patients needing exercise assistance.
  • The partners at the practice each had a personal assistant who was able to be contacted by patients requiring support. This enabled their named GP to be informed of any issues the patients on their list had.

Families, children and young people

Good

Updated 7 December 2016

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.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 81% compared to the CCG average of 83% and a national average of 82%.
  • 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 and health visitors.
  • The practice sent a “birthday card” to patients on their 15th birthday advising them of the services available to them.
  • The practice provided a drop-in clinic every Wednesday afternoon for young patients between 4pm and 4.30pm.
  • The practice was awarded a PACE Setter award in 2016 for their work in attempting to reduce teenage pregnancy.
  • The practice took part in a scheme where young people could show a card to receive free condoms.
  • The practice was the foodbank location for the village of Henfield.
  • The practice had received money from a legacy which allowed young diabetic patients to go on breaks organised by Diabetes UK which allowed them to talk to other young diabetic patients and assist in managing their condition.

Older people

Good

Updated 7 December 2016

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 provided care to two local care homes, each with approximately 50 beds and undertook weekly visits to the patients there.
  • The practice was active in the pro-active care scheme which identified patients at risk of unplanned admission to hospital and met fortnightly with the team involved to discuss care plans and cases.
  • The practice provided educational sessions for nursing home staff in areas such as diabetes care.

Working age people (including those recently retired and students)

Good

Updated 7 December 2016

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.
  • Early morning appointments from 7am were offered four days a week.
  • The practice offered telephone appointments where appropriate.
  • The practice offered electronic prescribing so patients could collect prescribed medicines from a location of their choice.
  • The practice had a Facebook page to keep in contact with patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 December 2016

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

  • 81% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95% compared to the CCG average of 90% and a national average of 88%.
  • 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.
  • The practice maintained links with a local charity called “Know dementia”. This allowed further support for patients with dementia.
  • The practice had undertaken two separate training days specifically on mental health issues in July 2015 and October 2016.

People whose circumstances may make them vulnerable

Good

Updated 7 December 2016

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.