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Yardley Green Medical Centre Good Also known as Yardley Doctors

Inspection Summary


Overall summary & rating

Good

Updated 21 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Waddell and partners practice also known as Yardley Green Medical Centre on 14 April 2016. The overall rating for the practice was good. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Waddell and partners practice surgery on our website at www.cqc.org.uk.

This inspection was an announced desk based inspection carried out on 23 June 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall, the practice continues to be rated as good.

Our key findings were as follows:

  • Documentation provided as part of our desktop review showed that all non-clinical staff had a Disclosure and Barring Service DBS check in place.

  • At our April 2016 inspection, health and safety risk assessment we viewed lacked sufficient details to enable effective management of risks. As part of our desktop review, the practice provided copies of their health and safety risk assessment, which showed clear procedures for monitoring and managing risks. The practice also provided copies of a detailed cleaning schedule policy which demonstrated measures to maintain standards of cleanliness.

  • Data from 2015/16 QOF year showed that overall clinical exception reporting rate remained above average. For example, 18%, compared to local and national average of 10%. The practice provided unverified data from 2016/17 QOF year which showed exception reporting for mental health, Asthma, Chronic Obstructive Pulmonary Disease (COPD) and cervical screening remained above local and national average. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

  • The practice was aware of their performance and continued to follow recognised processes to improve performance.

  • A nominated staff member was responsible for overseeing the patient recall system to ensure health review reminder letters were combined into one invite rather than patients receiving several different reminders letters. The practice also explained that they were planning to run several drop-in clinics for rheumatoid arthritis, dementia and other health related issues in order to offer more flexibility for patients to attend.

  • At our previous inspection, we found that the when responding to complaints the tone of the responses was not always sensitive to the concerns of the complainant.Documentation provided by the practice as part of this desktop review showed that the practice responded to complaints with openness and transparency.

  • Results from the January 2016 national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was below local and national averages with the exception of patients who found it easy to make an appointment with a named GP.

  • Results from the July 2016 national GP patient survey showed that patient satisfaction had declined in some areas and improved in other areas. For example, satisfaction with the practice opening times and phone access had declined. However, access to a preferred GP had improved.

  • The practice carried out internal surveys to monitor patient satisfaction. Unverified data provided by the practice showed that within a three month period the practice answered between 94% and 98% of all calls.

  • The practice’s computer system alerted GPs if a patient was a carer. Staff we spoke with explained that since the previous inspection the practice updated their carers form and increased the amount of carers’ posters around the practice. We were also told that further improvements include updating carers’ information on the practice website and staff were developing a carer’s corner with the support of their patient participation group (PPG).

However, there were also areas of practice where the provider needs to continue to make improvements. For example, the provider should:

  • Continue to review national GP patient survey results and explore effective ways to improve patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 July 2017

At our previous inspection on 14 April 2016, we rated the practice as requires improvement for providing safe services as some necessary employment checks had not been carried out and some risks were not effectively managed. These arrangements had significantly improved when we undertook a desktop review on 23 June 2017. For example:

  • Previously we saw that in the absence of a Disclosure and Barring Service (DBS) check, the practice had not risk assessed non-clinical staff who acted as a chaperone. Documentation provided as part of our desktop review showed that all non-clinical staff had a DBS check.

  • At our April 2016 inspection, health and safety risk assessment we viewed lacked sufficient details to enable staff to continue mitigating risks. As part of our desktop review, the practice provided copies of their health and safety risk assessment, which showed clear procedures for monitoring and managing risks.

  • When we carried out our previous inspection, there were no clear guidelines or records to indicate how frequently carpets should be deep cleaned. As part of our review we saw a detailed cleaning schedule policy which enabled the practice to maintain standards of cleanliness.

  • Members of the management team we spoke with explained that since the April 2016 inspection, controlled drugs (medicines that require extra checks and special storage because of their potential misuse) which were awaiting an appropriate witness so that they could be destroyed had been appropriately removed.

Effective

Good

Updated 21 July 2017

Caring

Good

Updated 21 July 2017

Responsive

Good

Updated 21 July 2017

Well-led

Good

Updated 21 July 2017

Checks on specific services

People with long term conditions

Good

Updated 10 June 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 received regular review of their condition. The practice provided dedicated clinics for patients with diabetes, respiratory conditions and coronary heart disease.
  • Performance for diabetes related indicators was 97% which was higher than both the CCG average and national average of 89%. However there were also higher exception reporting levels.
  • Longer appointments and home visits were available for those who needed them.
  • The practice worked with relevant health and care professionals to deliver a multidisciplinary package of care for those with complex health care needs.
  • The practice provided in-house diagnostic and monitoring services for the convenience of patients. Including spirometry, electrocardiographs, 24 hour ambulatory blood pressure monitoring.
  • The practice had a high prevalence of diabetes and proactively supported patients newly diagnosed with type 2 diabetes through monthly in house training and education clinics.

Families, children and young people

Good

Updated 10 June 2016

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

  • The practice had a predominantly young population.
  • 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. Regular meetings took place with the health visitor.
  • Nationally published data available for immunisation rates for standard childhood immunisations were comparable to the CCG averages for under two year olds but slightly lower for the under five year olds. More recent data provided by the practice showed the practice was meeting childhood immunisation targets.
  • Children and young people were treated in an age-appropriate way and were recognised as individuals. Priority was given to children to be seen the same day if needed and open access child surveillance clinics operated from the premises once a week.
  • Appointments were available outside of school hours and the premises were suitable for children and babies including a breast feeding friendly service.
  • The practice’s uptake for the cervical screening programme (2014/15) was 77%, which was below the CCG average of 79% and the national average of 82% with higher exception reporting. The practice had dedicated administrative support to remind and follow up patients who did not attend for their cervical screening test before exempting. Practice data for cervical screening 2015/16 showed improvements with 84% of patients screened in the last 5 years.

Older people

Good

Updated 10 June 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. Care plans were in place for those with complex care needs.
  • The practice worked as part of a multidisciplinary team to support those with complex and end of life care needs.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice was accessible to those with mobility difficulties.
  • The practice undertook weekly visits to a local nursing home. Feedback on the support provided was positive.

Working age people (including those recently retired and students)

Good

Updated 10 June 2016

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

  • The practice was proactive in offering online services for appointments and repeat prescriptions.
  • A text message service was used to remind patients of appointments and to make it easier to cancel.
  • Health promotion and screening services were available that reflected the needs of this age group.
  • Sexual health and family planning services were available for registered and non-registered patients.
  • The practice did not offer any extended opening hours for the convenience of patients who worked during the day although staff said they would try and be flexible and see patients outside of clinic times if patients were otherwise unable to attend.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 June 2016

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

  • National reported data from 2014/15 showed that 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was below the CCG average of 82% and national average of 84%.

  • National reported data from 2014/15 showed performance against mental health related indicators was 100% which was above the CCG average of 92% and the national average of 93%. However the practice also had high levels of exception reporting.

  • The practice offered depot injections for the convenience of patients, avoiding the need to attend hospital for this.
  • Longer appointments were available for undertaking mental health reviews.

People whose circumstances may make them vulnerable

Good

Updated 10 June 2016

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

  • The practice held registers of patients living in vulnerable circumstances for example, those with a learning disability and carers. Patients with no fixed abode were also able to register.
  • 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 provided information to patients such as carers 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.
  • Translation services were utilised for patients whose first language was not English and some of the staff were able to speak more than one language. However, written information in languages other than English was not routinely available.