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Patterdale Lodge Medical Centre Good Also known as Patterdale Lodge Group Practice

Inspection Summary


Overall summary & rating

Good

Updated 1 August 2018

In addition, the provider should:

  • Review incident reporting to ensure these are recorded in a timely manner.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 August 2018

The practice is now rated as good for providing safe services. At our previous inspection on 11 October 2017, we rated the practice as requires improvement for providing safe services. These arrangements had significantly improved when we undertook a follow up inspection on 6 July 2018. Staff records now contained all the required information to demonstrate their suitability for their roles.

Safety systems and processes

  • At the previous inspection personnel files did not provide evidence that a robust and safe recruitment process was in place. At this follow-up inspection we saw significant improvements and all the required recruitment documents were in place to evidence that the required checks had been completed prior to employment. We reviewed a number electronic and paper personnel files including the most recently recruited member of staff. The records included photographic identification and confirmation of address, previous employment history, a reference from the most recent employer, health declarations and qualifications as appropriate to the role. The provider had completed a Disclosure and Barring Service (DBS) check as required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.)
  • An electronic system was in place to record training, employment records and revalidation information. We saw that professional certificates had been scanned and professional registration numbers recorded.
  • At the previous inspection the management of the significant events and learning from incidents were not formal. At this follow-up inspection we found that although staff stated that formal processes were now in place to record and cascade learning from events these had not yet been used. During this follow-up inspection staff described a recent event, the immediate action taken and the changes made to prevent a similar occurrence, however, this had not been logged and written up at the time of the inspection. Meeting notes we reviewed indicated that staff were reminded to log all incidents and personal learning, however there was no evidence, in the notes, of incidents being discussed with the wider team.
  • At the previous inspection a Legionella action plan in response to the risk assessment completed in June 2017 was not in place. (Legionella is a term for a bacterium which can contaminate water systems in buildings). At this follow-up inspection we found that an improvement plan had been implemented, this included replacing water heaters and ensuring the appropriate water temperature checks were completed at the main and branch surgeries.

Safe and appropriate use of medicines

  • At the previous inspection we found the system for managing emergency medicines should be reviewed. At this follow-up inspection we found action had been taken to introduce an emergency medicines checklist at the main surgery and both branch surgeries. However, the items stored in the emergency medicines box at the main surgery needed to be reviewed and it was noted that one of the medicines recommended in best practice guidance was not available. This was discussed with the provider who took steps to provide the medicine in the three surgeries as quickly as possible. Following the inspection, the provider provided a statement confirming the suggested medication was made available at the main surgery on that day and delivered to the branch surgeries on the following day.
  • At the previous inspection we found systems for managing uncollected repeat prescriptions had not been reviewed. At this follow-up inspection we found a review had taken place and the practice’s pharmacist was now responsible for dealing with uncollected repeat prescriptions.
  • At the previous inspection we found systems for monitoring the two-week referral system had not been reviewed. At this follow-up inspection we found that a system for monitoring process to check on the outcomes of two-week referrals was in place.
  • At this follow-up inspection we found a ‘Safe and reliable management of test results’ policy had been introduced. This provided clear guidance about the action needed by doctors and allocated administration staff to ensure urgent referrals were made and monitored.

Effective

Good

Updated 15 December 2017

The practice is rated as good for providing effective services. Patients’ needs were assessed and care was planned and delivered in line with current legislation. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Staff worked with other health care teams and there were systems in place to ensure appropriate information was shared. Staff felt supported and they told us they had

access to training and development opportunities appropriate to their roles.

Caring

Good

Updated 15 December 2017

The practice is rated as good for providing caring services. Patients spoken with and who returned comment cards were positive about the care they received from the practice. Responses to the National GP Patient Survey (July 2017) relating to the caring approach of the practice were in-line with local and national averages. We observed staff engaging with patients in a professional and respectful manner.

Responsive

Good

Updated 15 December 2017

The practice is rated as good for providing responsive services. Services were planned and delivered to take into account the needs of different patient groups. A range of access to the service was provided and this was monitored to ensure it met the needs of patients.

The practice had a complaints policy which provided staff with guidance about how to handle a complaint.

Well-led

Good

Updated 15 December 2017

The practice is rated as good for providing well-led services. The practice had a vision and strategy to deliver high quality care and promote good outcomes for patients. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance and staff meetings. However work was needed to ensure health and safety systems and processes were effectively monitored to ensure safety and service improvement.

Checks on specific services

People with long term conditions

Good

Updated 15 December 2017

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

  • Nursing staff had lead roles in long-term disease management. However there was no effective system in place to recall patients for a structured annual review to check their health and medicines needs were being met.

  • Patients at risk of hospital admission were identified as a priority.

  • 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.

  • The practice had employed a Practice Pharmacist to review those patients on multiple medicines to optimise their care.

  • Longer appointments and home visits were available when patients needed them.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

Families, children and young people

Good

Updated 15 December 2017

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

  • Immunisation rates were 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. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 15 December 2017

The practice is rated as good for the care of services for older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice had established a pilot scheme to visit their patients living in care and nursing homes on a weekly basis to prevent unplanned admissions to hospital and to improve health outcomes for patients.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice had two carer champions to support and signpost carers.

  • 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 followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Working age people (including those recently retired and students)

Good

Updated 15 December 2017

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

  • The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 7.30pm Monday to Wednesday and 8am to 6.30pm Thursday to Friday.

  • The practice had two branch surgeries that patients could access GP and nursing appointment from throughout the week.

  • Patients could book routine appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice.

  • The service offered a medical triage service to ensure patients were seen by the most appropriate clinician. Telephone consultations were also offered.

  • The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, contraceptive services, smoking cessation advice and family planning services.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 December 2017

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

  • GPs worked with specialist services to review care and to ensure patients received the support they needed.

  • The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review.

  • The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice referred patients to appropriate services such as memory clinics, psychiatry and counselling services.

  • Patients were also signposted to relevant services such as Age UK, and the Alzheimer’s Society and were offered resources such as talking therapies and on-line self-help resources.

  • The practice offered patients with poor mental health the option of ordering their medication over the telephone.

People whose circumstances may make them vulnerable

Good

Updated 15 December 2017

  • The practice held a register of patients living in vulnerable circumstances including 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 knew how to contact relevant agencies in normal working hours and out of hours.