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The Castle Medical Centre Outstanding


Inspection carried out on 5 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Castle Medical Centre on 5 March 2015. Overall the practice is rated as outstanding.

Specifically we found the practice to be good for providing safe and caring services. It was outstanding for providing effective, responsive and well led services. The practice was outstanding for providing services to families, children and young people, working age people and those whose circumstances may make them vulnerable. It was also outstanding for providing services to people with long term conditions, older people, and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • The practice assessed patients’ needs and planned their care following best practice guidance.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned. The practice valued the importance of quality, improvement and learning and were actively involved in GP education and training and in primary care research.
  • Patients said they were treated as individuals and that they were involved in their care and decisions about their treatment. Patients described the practice as caring, helpful and friendly.
  • Information about services and how to complain was available and easy to understand.
  • Patients could speak on the telephone and make an appointment with a named GP. Routine as well as urgent appointments were available on the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Plans were in hand for extending and improving the building to enable the practice to respond to future patient needs.
  • There was a clear leadership structure and staff felt supported by management. The practice worked closely with its patient participation group and proactively sought feedback from staff and patients. They listened to what patients told them and made improvements accordingly.

We saw several areas of outstanding practice including:

  • The practice had effective assessment, care planning and recall arrangements for patients with long term conditions. Their emergency admission rates for a number of long term conditions including chronic heart disease and chronic obstructive pulmonary disease (COPD) were significantly below the national average. The practice also had low accident and emergency admission rates.
  • The practice team included a part time pharmacist employed by the practice to support the clinicians in providing safe and effective medicines management. Their role included supporting the GPs and nurses with pharmacy advice, reviewing prescribing and monitoring medication safety alerts to make sure these were acted on in a timely way. The practice told us that having a pharmacist had resulted in them being one of the most cost effective prescribers within the CCG. National data showed prescribing levels for specific types of medicines where caution should be exercised were lower than the national average.
  • The practice was working to develop the service it provided to patients with dementia and their carers. In addition to care planning and reviews of their care they had arranged a talk for patients and carers by staff from the Office of the Public Guardian (OPG) about how to make a lasting power of attorney (LPA) and another by the Alzheimer’s Society. These were the first of a series of patient education evenings the practice planned to arrange for patients each year.
  • The practice attended a weekly multi-disciplinary meeting at a local care home that was involved in an early discharge from hospital initiative. One of the GPs visited patients staying at the home under this scheme every day. Appointments for older patients’ health reviews were 30 minutes long and hour long appointments were booked for those most at risk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice