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Mauldeth Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 23 May 2018

This practice is rated as Good overall. (Previous inspection April 2017 – Good)

We carried out an announced comprehensive inspection at Mauldeth Medical Centre on 10 April 2017. The overall rating for the practice was good with key question Effective rated as requires improvement. At that inspection we found improvements were needed as the practice had failed to implement a safe system of patient recall for those prescribed high risk medicines and systems to monitor the effectiveness of clinical audit and other quality improvements to improve patient care were not in place. We issued two requirement notices in respect of Safe care and treatment and Good governance; regulations 12 and 17 HSCA (RA) Regulations 2014. We identified one other area the practice should develop and this was to identify patients who were carers so services could be offered to meet their needs.

The full comprehensive report on the April 2017 inspection can be found by selecting the ‘all reports’ link for Mauldeth Medical Centre on our website at

This inspection was a focused visit to the practice on 25 April 2018 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 on 10 April 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

This focused inspection visit identified improvements had been made in service delivery for key question Effective and this is now rated good.

Our key findings were as follows:

  • At our previous inspection in April 2017 we found systems to monitor patients with chronic long term health conditions or monitor those patients prescribed high risk medicines were not effectively established. At this inspection there was clear evidence available to demonstrate the practice had reviewed its systems and had implemented action to ensure continuous ongoing monitoring of patients with a long term condition and those prescribed high risk medicines.

  • The previous inspection identified that clinical audit was not linked to patient outcomes. At this inspection visit we reviewed a number of audits including those for high risk medicine, asthma control and one for end of life. These audits demonstrated the practice linked the quality improvement work with patient outcomes.

  • At the inspection in April 2017 we identified that some patients’ electronic records had not been correctly coded. Following that inspection the practice undertook a data cleansing exercise of the patient electronic system and one GP partner undertook the lead role for monitoring the patient electronic system to ensure it was accurate.

  • The previous inspection identified that some performance indicators for diabetes and cervical cytology were below the local and national averages. The practice was implementing action to address these issues including providing additional training for one practice nurse to develop their expertise in the management of diabetes and one practice nurse had been trained in cervical cytology.

The areas where the provider should make improvements are

  • Continue to implement action to improve the practice performance in the management of patients with diabetes and cervical cytology.

  • Continue to promote the practice carers’ register and encourage patients to identify themselves as carers.

Inspection areas

Safe

Good

Effective

Good

Updated 23 May 2018

We rated the practice and all of the population groups as good for providing an effective service.

At our previous inspection on 10 April 2017, we rated the practice as requires improvement for providing effective services as we found a system of monitoring patients and a patient recall process for those prescribed high risk medicines was not in place. Also systems to monitor the effectiveness of clinical audit and other quality improvements to improve patient care were not implemented effectively. We also identified one other area for further improvement and this was to identify patients who were carers so services could be offered to meet their needs.

These arrangements had improved when we undertook a focused inspection on 25 April 2018.

The practice is now rated as good for providing effective services.

Monitoring care and treatment

Since our previous inspection in April 2017 the practice had taken action to improve its programme of quality improvement activity and this was reviewed regularly to ensure appropriate and effective care was provided.

  • At the last inspection we found there was not an effective system in place to monitor patients with chronic long term health conditions or monitor those patients prescribed high risk medicines. At this inspection there was clear evidence available to demonstrate the practice had reviewed its systems and had implemented action to ensure continuous on-going monitoring of patients with a long term condition or those prescribed high risk medicines. For example:

  • The practice had recorded registers of patients for each long term condition and implemented a system of monthly checks to ensure patients were called in for their required health care review. The practice sent out up to three letters to patients requesting they make an appointment for their review and the practice nurse also contacted patients as required by telephone. Written records we viewed showed details of appointments made by patients and those who required additional contact to make appointments. The practice had a Call and Recall policy in place which was reviewed annually.

  • A High Risk Medicine Protocol and a Drug Monitoring Record sheet was in place for those patients prescribed medicines considered high risk due to the severity of potential side effects. This identified the range of medicines that required patients to undergo additional health checks such as regular blood tests. Monitoring records were available for patients prescribed a range of different high risk medicines including DMARDs (disease modifying anti-rheumatic drugs), lithium prescribed to some patients with mental health conditions, medicines prescribed to patients with chronic kidney disease and those prescribed blood-thinning medicine. Quarterly audits were undertaken to demonstrate how effective the practice was in implementing and ensuring patients received the correct level of health care checks and review.

  • The previous inspection identified that clinical audit was not linked to patient outcomes. We reviewed a number of audits including the high risk medicine audits, audits for asthma control and end of life audit including death in the preferred place of care. These audits demonstrated the practice linked the quality improvement work with patient outcomes. For example, a re-audit of asthma patients identified that those who attended for a follow-up review all had improved peak flow rates. (Peak flow measurement is a test to measure air flowing in and out of the lungs).

  • A coding/summarising policy was available, which detailed how staff should input/update electronic patient information in the form of a Read code. (A Read code is the letter and number code that uniquely identifies the patient’s health care condition). At the inspection in April 2017 we identified that some patients’ electronic records had not been correctly coded. Following that inspection the practice undertook a data cleansing exercise of the patient electronic system and one GP partner undertook the lead role for monitoring the patient electronic system to ensure it was accurate. The GP partner also provided a staff training day and team meeting minutes demonstrated that Read coding was discussed with the whole team.

  • The previous inspection identified that some performance indicators (diabetes and cervical cytology) for the Quality and Outcomes Framework (QOF) were below the local and national averages. The practice was implementing action to address these issues including providing additional training for one practice nurse to develop their expertise in the management of diabetes and one practice nurse had been trained in cervical cytology. The practice implemented their policy of sending out recall letters and telephone calls for people who did not attend. The practice recognised this was an area requiring continuous improvement.

  • The practice had since the previous inspection designated a member of staff as the Carers’ Champion who encouraged and signposted patients to the relevant support agencies. A Carers policy was available and a Carers toolkit. The practice had seven patients on their carers’ register. The practice manager confirmed they continued with efforts to increase their patient register of carers.

Caring

Good

Responsive

Good

Well-led

Good
Checks on specific services

People with long term conditions

Good

Updated 30 May 2017

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • 52% of patients with diabetes, on the register, who had IFCCHbA1c of 64 mmol/mol or less in the preceding 12 months (01/04/2015 to 31/03/2016) in comparison to the clinical commissioning group (CCG) and national average of 78% and 78% respectively.
  • 84% of patients with COPD had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (01/04/2015 to 31/03/2016) which was similar to the CCG and national average of 86% and 90% respectively.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP however, there was not an effective system in place to recall patients for a structured annual review to check their health and medicines needs were being met. For example; published data for 2015/16 showed 10 patients with chronic kidney disease (CKD). We carried out a search and identified 87 patients were in fact being treated for CKD. We saw one patient had not had any blood or urine samples tested since 2015.
  • 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.

Families, children and young people

Good

Updated 30 May 2017

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group.
  • The practice’s uptake for the cervical screening programme was 64% (2015/2016), which was worse than the CCG average of 82% and the national average of 81%.

Older people

Good

Updated 30 May 2017

  • Staff were able to recognise the signs of abuse in older patients and described the process for how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • Home visits were provided when necessary.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice worked closely with the ‘neighbourhood team’ this is a multi-disciplinary team who met regularly to discuss patients with complex care needs. Meetings were regularly held with MacMillan nurses to discuss patients who needed end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services. For example; district nurses and Macmillan nurses.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible such as; healthy eating and keeping active.
  • Some older patients with long-term health conditions were not receiving appropriate reviews.

Working age people (including those recently retired and students)

Good

Updated 30 May 2017

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
  • Appointments were available from 8.30am to 8.00pm and could be booked 6 months in advance via telephone or online with a doctor of patients’ choice. GPs and the practice nurse were available for telephone consultations each day and GPs answered patient email enquiries. The practice was open until 8.00pm two evenings a week. A blood test clinic was available two mornings a week to support working patients.
  • 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.
  • GPs referred patients who were students to the Manchester University counselling service for their emotional care needs. The Owens Park site is part of Mauldeth Medical Practice and is located in the ground of Manchester University. Staff based there supported students enrolled at the university.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 May 2017

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice carried out advance care planning for patients living with dementia.
  • 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the clinical commissioning group (CCG) and national average 86% and 84% respectively.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example a nominated GP from the practice visited a local residential home twice a week.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses whom had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) which was above the CCG and national average of 86% and 89% respectively.
  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (01/04/2015 to 31/03/2016) which was higher than the CCG and national average of 87% and 89% respectively.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 30 May 2017

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.