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West Bridgford Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of West Bridgford Medical Centre on 15 September 2015. We found that some requirements were not in place or sufficiently robust, and supporting evidence was not always available. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements and ensure that effective procedures were followed.

We undertook this focused inspection of the practice on 6 June 2016, to check that improvements had been made to meet legal requirements following our comprehensive inspection. We spoke with the practice manager and reviewed documents to demonstrate that the provider had taken action to address the issues identified at the last inspection.

Overall the practice is rated as good. Our findings across the areas we inspected were as follows:

  • The practice had strengthened systems for assessing environmental and health and safety related risks. Monthly meetings were in place between the practice manager and site manager to discuss site related issues. The practice was developing its own risk assessments when practice-specific concerns were identified.

  • A designated infection control lead had been appointed. Infection control policies had been updated, and an infection control audit had been completed. Staff induction had been revised to include infection control awareness for all new staff.

  • All staff had now received an annual appraisal. Appraisals had been documented and included personal objectives and a review of any training requirements.

  • The appointment of a Practice Administrator had strengthened managerial capacity in the practice. The provider had reviewed succession planning arrangements for the future.

  • The practice had a governance framework which supported the delivery of good quality care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 June 2016

Effective

Good

Updated 23 June 2016

Caring

Good

Updated 23 June 2016

Responsive

Good

Updated 23 June 2016

Well-led

Good

Updated 23 June 2016

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

The systems in place to enable the provider to have effective oversight of risk, enabling issues to be identified, assessed and mitigated had improved since our inspection on 15 September 2016.

For example, systems to manage the prevention and management of infection control had been enhanced by the appointment of a designated practice lead. Annual staff appraisals had been completed for all members of the team. Regular meetings had been established between the practice manager and site manager to facilitate communications on environmental and premises concerns.  Succession planning arrangements had been reviewed to ensure service continuity and managerial capacity had been enhanced by the recruitment of a Practice Administrator.

Checks on specific services

People with long term conditions

Good

Updated 17 December 2015

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

The practice had named clinicians including GPs, nurses and the pharmacist to lead specific areas of chronic disease management, ensuring a multi-disciplinary approach to the management of long-term conditions. There was a monthly recall of patients which incorporated a single appointment for those presenting with multiple conditions. Patients were kept under review at a quarterly multi-disciplinary meeting involving all relevant team members involved in the patients’ care packages.

A number of audits were carried out for patients with long term conditions, including one to identify at-risk patients who were being prescribed medicines commonly associated with prescribing errors to enable corrective action to be taken reducing the risk of this happening. .

The practice had developed an asthma self-management plan in conjunction with patients. The pharmacist has been invited to the Nottingham Asthma Task Group to speak about this development.

We received comment cards from two patients with long term conditions which confirmed their health needs were monitored carefully and that they received regular health checks.

Families, children and young people

Good

Updated 17 December 2015

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

There were systems in place to identify children who were at risk, for example, children and young people who had a high number of A&E attendances. There was a robust call and recall process in place for child immunisations and immunisation rates were relatively high for all standard childhood immunisations. For example, the percentage of two year old children receiving vaccinations ranged from 95%- 96.7% and this was in line with the CCG average. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Parents we spoke with confirmed that they had received explanations about vaccines to enable them to make informed decisions about their child’s health and wellbeing. Nurse appointments were available outside of school hours and the premises were suitable for children and babies. There was evidence of regular joint working with midwives and health visitors. Patients were able to access baby changing and breast feeding facilities on site.

Older people

Good

Updated 17 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. The practice offered care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Every patient over the age of 75 had been allocated a named responsible GP, and had been informed of this in writing.

The practice employed pharmacist undertook full clinical medication reviews of newly registered older patients and others referred by the GP. Additional paper-based medication reviews were also undertaken, for example post hospital discharge and from risk-based indicators. A description of this service was recently published by the practice pharmacist and lead GP in ‘Prescriber’, a journal for health professionals about medicines management.

Working age people (including those recently retired and students)

Good

Updated 17 December 2015

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

The age profile of patients at the practice fell mainly within this population group. The needs of the working age population, those recently retired and students had been identified and the practice offered services to ensure these were accessible, flexible and provided continuity of care. The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

The practice planned to introduce early morning appointment times from 1 October 2015. The capacity for appointments was planned to increase as the practice were actively recruiting a new GP. The practice supported a weekend GP service which enabled greater access for patients beyond standard opening hours. This is funded by the Prime Minister’s Challenge Fund and is part of a wider scheme across all CCG practices.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). A call and recall system was in place for the annual review of all mental health patients. Longer appointments were offered to accommodate patients’ needs.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. Staff had received training on how to care for people with dementia. Carers of patients with dementia were identified for a well person’s check and invited to attend for an annual influenza vaccination.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, and data provided by the CCG demonstrated that the practice made appropriate referrals to other services when indicated. It had a system in place for the GP to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

There was a named clinical lead in the practice for mental health

People whose circumstances may make them vulnerable

Good

Updated 17 December 2015

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

There was a named GP Clinical Lead to oversee care for patients with a learning disability. The practice had carried out annual health checks for people with a learning disability and 86% of patients on the register had been reviewed. The practice worked closely with six local learning disability care homes where the practice provided support, undertaking visits if the patients were not able to attend surgery. Longer appointments were offered to accommodate the needs of patients with a learning disability.

We received comments from a representative of one of the learning disability homes covered by the practice, who told us that the service received was excellent and that the doctor took time to explain procedures and treated patients with compassion and care.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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 when to report concerns.

The practice actively worked with The Carers Federation to identify carers and signpost them to relevant support. A Carers Federation representative attended the surgery weekly, and met regularly with the practice manager