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Moss Valley Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We previously carried out a comprehensive inspection of Moss Valley Medical Practice on 29 April  2015. The overall rating was good.

We carried out a focused inspection of Moss Valley Medical Practice on 7 November 2016, in response to some shared concerns around the handling of acute prescriptions and significant events. We visited the practice as part of this inspection.

We reviewed the practice against two of the five questions we ask about services: are services safe and well-led. The overall rating was good. Our key findings were as follows:

  • Most patients we spoke with were very satisfied with the care and treatment they received.
  • Moss Valley Medical Practice merged with Gosforth Valley Medical Practice in April 2016, to form a main practice and a  branch surgery. Essential changes were being made following the merger to align the practices

    to 

    ensure a consistent approach to managing the services. Standard procedures and systems were being put in place to ensure the services are safe and well-led. 

  • The practice had systems in place to ensure prescriptions were provided in accordance with patient need. The policy relating to issuing of prescriptions needed to be updated, to reflect the current process for providing acute prescriptions to patients in care homes

  • There was an open culture to reporting safety incidents and near misses. Significant events were appropriately managed and action was taken to prevent further incidents. However, the policy was not up-to-date as it did not detail the processes followed in practice for reporting, recording, and acting on significant events. Following the inspection, we received a copy of the updated policy.   

The areas where the provider should make improvements are:

  • Review the policies around prescribing to ensure these describe all processes followed in practice.

  • Align and strengthen the systems for managing and monitoring significant events and safety incidents. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 December 2016

The practice is rated as good for providing safe services.

  • There was an open culture to reporting incidents. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • The practice had systems in place to ensure prescriptions were provided in accordance with patient need. The policy relating to issuing of prescriptions 

    needed to be updated, to reflect the current process for providing acute prescriptions to patients in care homes

    .

  • Significant events were appropriately managed and acted on to prevent further incidents. However, the policy was not up-to-date as it did not detail the 

    processes followed in practice 

    for reporting, recording and acting on significant events. Following the inspection, we received a copy of the updated policy.

  • ​Lessons were shared with staff and improvements where made where required to improve safety in the practice.

Effective

Outstanding

Caring

Good

Responsive

Good

Well-led

Good

Updated 9 December 2016

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

  • Moss Valley Medical Practice merged with Gosforth Valley Medical Practice in April 2016, to form a main practice and a branch surgery. Essential changes were being made following the merger to align the practices, to ensure

    a consistent approach to managing the services.

    Standard procedures and systems were being put in place to ensure the services are safe and well-led.

  • A clear leadership structure was set out, which had been strengthened following the recent merger.​

  • Staff had taken on additional responsibilities and lead roles for specific areas, to ensure the services are effective and to drive continuous improvements across both sites.

  • The practice had effective systems in place to monitor and improve the safety of the services provided, relating to

    significant events 

    and 

    the management of medicines.

Checks on specific services

People with long term conditions

Good

Updated 19 November 2015

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

A clinician held lead responsibility for each long-term condition which allowed them to develop personal expertise and provide supervision and learning to other staff. The practice pharmacist and nurses support the GPs in their work to provide care to patients in this group.

Longer appointments and home visits were available when needed. The practice had achieved 100% QOF points in 2014/15 and this was reflected in the robust disease management processes we saw. The practice had introduced an annual review for patients where all conditions could be managed within one visit split across nine months and effective recall systems were in place.

. For those people 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 19 November 2015

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 those who were at risk, for example, children and young people who had a high number of A&E attendances.

Immunisation rates were high for all standard childhood immunisations and exceeded local and national averages. For example infant Hib, Infant MEN C and the combined booster were all at 100% compared to a CCG average of 98.2% to 99.1%

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. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had a community focus in the way it provided care and treatment to the younger population group and acutely unwell young people could access an appointment even if they were not registered patients.

We saw good examples of joint working with midwives, health visitors and school nurses. Including GP's attending the local school to deliver health information sessions.

All GP partners had gained additional diplomas in family planning and were able to offer comprehensive sexual health advice to all patients. This had improved access to care and advice for patients which was evidenced by the practice achieving 100% of all Quality and Outcome Framework performance points for contraception, maternity services, and cervical screening, which exceeded local and national averages. For example rates for cervical screening were 79.2% which exceeded the local CCG national figures of 79% and 74%

Older people

Good

Updated 19 November 2015

The practice is rated as good for the care of older people. The practice employed a care coordinator and community matron who assisted older and vulnerable patients after their hospital discharge and with accessing social care. Weekly ward round visits and weekly medicines reviews were carried out by the practice to three local care homes which staff at the care homes and practice told us had resulted in lower emergency admissions and improved communication with staff. Data showed that Emergency admissions for patients aged 65-75 amongst the lowest in the CCG area at 230 admissions per 1000 patients compared to a CCG average of 250. Staff at a local care home told us the medicines reviews undertaken by the community pharmacist employed at the practice had led to an almost total reduction in prescription of anti-psychotics which had led to a decrease in the number of falls by patients registered at the practice who lived in the care home.

Patients over the age of 75 years had a named GP to ensure continuity in care. Monthly end of life care meetings were held with non-practice staff.

The practice operated an on call rota system to allow flexible home visits to patients requiring this and to maintain continuity of care. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. For example the percentage of rheumatoid arthritis patients who had received an assessment of fracture risk was 90.9% compared to local and CCG averages of 86.1% and 82.1% respectively.

Working age people (including those recently retired and students)

Good

Updated 19 November 2015

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

The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Patients told us they had chosen to register with the practice due to the convenience of opening times and access to appointments.

The practice was proactive in offering online services such as electronic prescriptions and appointment booking, as well as a full range of health promotion and screening that reflects the needs for this age group. Flexible telephone call back appointments are offered to meet the needs of working patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 November 2015

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

100% of people experiencing poor mental health had received an annual physical health check. The practice hosted an IAPT (Improving Access to Psychological Therapies) team which enabled access for patients.

The practice completed care plans for all 82 patients on their register with dementia. We saw that all 82 had received an annual review.

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.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 19 November 2015

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 looked after children, vulnerable adults and children and those with a learning disability. It had carried out annual health checks for people with a learning disability and all 43 patients had received a health review. It offered longer appointments for people with a learning disability or those who required them.

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 and excellent robust system were in place to identify and protect people who may be at risk of harm.

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. Non practice health care staff spoke positively about the practices involvement in safeguarding meetings.