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Inspection Summary


Overall summary & rating

Good

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Colne Medical Centre on 11 October 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff members knew how to raise concerns, and report safety incidents. Safety information was recorded and any learning identified was shared with staff members.
  • Risks to patients and staff members were assessed and documented regularly including those associated with; premises, equipment, medicines, fire safety, and infection control.
  • Patient care and treatment was planned using recommended current clinical guidance.
  • Patient comments were enthusiastic and positive about the practice.
  • The practice patient participation group (PPG) could demonstrate their involvement with practice development.
  • Information regarding how to complain was available at the practice and on their website.
  • Patients told us there were urgent appointments available on the day they requested.
  • The practice had appropriate facilities and equipment to treat patients and meet their health and treatment needs.
  • Staff members told us they were supported in their working roles by the practice management and the GPs.
  • Prescriptions waiting to be collected were not stored securely.
  • The dispensary processes and procedures were suitable to keep people safe. However staff members including the four nurses we spoke with could not tell us what to do if the refrigerators they were monitoring were found outside the limits of cold storage medicines.
  • The leadership structure was clear and staff felt supported by management.

The areas where the provider should make improvements:

  • Ensure prescriptions waiting to be collected are stored securely.
  • Ensure all staff members recording the temperature of refrigerators know what to do if they find them outside the limits for cold storage of medicine.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 December 2016

The practice is rated as good for providing safe services.

  • There arrangements in place to raise concerns, and report safety incidents. Incidents and lessons learned whilst investigating incidents were shared with staff members at practice meetings.
  • When things went wrong patients received an explanation or apology when appropriate.
  • The practice had developed processes to keep people safe and safeguarded from abuse.
  • Risks to patients were assessed and managed, these included premises, equipment, medicines, and infection control.
  • Prescriptions waiting to be collected were not stored securely.

Dispensary procedures kept people safe. However we found not all staff members including the nurses knew what to do if the refrigerators were outside the limits for cold storage of medicine.

Effective

Good

Updated 23 December 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcome averages were above local and national practices.
  • Patient care was planned and provided in a way that reflected best practice and followed recommended current clinical guidance.
  • Staff had the skills, local community knowledge, and experience to deliver effective care and treatment in a primary care environment.
  • Clinical audits undertaken at the practice showed that GPs used the information to improve the practice service quality and patient outcomes.
  • Arrangements were in place for staff to receive supervision and appraisals.
  • Meetings with multidisciplinary teams supported staff members to understand and meet the varied complexities of people’s needs.

Caring

Good

Updated 23 December 2016

The practice is rated as good for providing caring services.

  • Data from the ‘National GP Patient Survey’ published July 2016 showed patients rated the practice higher than other local and national practice averages for numerous aspects of satisfaction.
  • Patients told us they were treated with compassion, dignity, and respect. They also told us they were involved in decisions about their care and treatment. This was in line with the GP patient survey results.
  • We saw staff members behave respectfully, and considerately, ensuring they maintained patient information confidentiality.
  • Information for patients about the services available at the practice and on their website this was easy to understand and accessible.

The practice recognised patients who were carers on their computer records, the number identified was, 125 and this equated to 1.2% of the practice population.

Responsive

Good

Updated 23 December 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and the Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.

  • Patients said they found it easy to make an appointment with a GP and had continuity of care. We were also told urgent appointments were available on the same day requested.

  • The practice had good facilities and was well equipped to treat patients and meet their various health needs.

Information about how to complain was available in the practice and on their website. They had received four complaints in the last year; we saw they had been well managed.

Well-led

Good

Updated 23 December 2016

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

  • The practice had a clear vision and strategy to deliver high quality care, and promote good outcomes for patients. Staff members knew the practice vision and their role in relation to it.
  • There was a clear leadership structure and staff told us they felt supported by management.
  • The practice had policies and procedures to govern activity and held regular meetings where changes to their policies and procedures were discussed.
  • The GPs promoted a culture of openness and honesty, and the practice procedures to manage notifiable safety incidents, was shared with staff members to keep them well informed.
  • The practice sought feedback from staff and patients, which was used for development and improvement work. The patient participation group (PPG) actively supported the practice by offering their opinions and advice when requested.

There was a strong focus on continuous learning, development of services, and improvement at all levels; this was evidenced in staff records, patient satisfaction and the quality of work.

Checks on specific services

People with long term conditions

Good

Updated 23 December 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 at risk of hospital admission were identified as a priority.

Diabetic quality data from 2015 to 2016 showed:

  • The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months, was 73% (local practices 75% and nationally 79%).
  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 82% (local practices 78% and nationally 77%).

Other services provided by the practice for this population group were:

  • Longer appointments and home visits when needed.
  • A named GP and a structured annual review to check their health and medicine requirements were being maintained and met.
  • A patient’s named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.
  • The practice nurses had received specialist training in diabetes, asthma, and chronic obstructive pulmonary disease, to support the GPs manage long term condition patients.
  • GP written alerts were designed to ensure patient’s received the blood tests, and diagnostic checks required before repeat prescriptions were provided.
  • There was a practice based blood taking service to support patients in this population group that would struggle to access local hospital blood taking clinics.

Regular drug monitoring searches were undertaken for patients taking high risk medicine and medicines that required extra monitoring. This ensured patients’ conditions could be kept stable when taking these medicines.

Families, children and young people

Good

Updated 23 December 2016

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

  • There were systems in place to follow up children living in disadvantaged circumstances or at risk; for example, children and young people who had experienced a high number of A&E attendances.
  • Immunisation rates were high for all standard childhood immunisations in comparison with practices locally and nationally.
  • Parents of children we spoke with told us they were treated in an age-appropriate manner; that questions were encouraged, and easy to understand language was used during consultations to explain treatment.
  • Patients aged 25-64, attending cervical screening within the target period of 3.5 or 5.5 years coverage was .
  • Appointments were accessible outside school hours.
  • We were told by the practice nurses there was positive joint working with community professionals; for example space for the community midwives providing regular clinics. The GPs provided post-natal and six week baby checks.
  • On-line appointments were available for both advanced and on the day appointments.

The practice told us they ensured all babies, children and young people were seen on the day, this included a number of urgent appointments available each afternoon.

Older people

Good

Updated 23 December 2016

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

  • The practice was responsive to the needs of older people, and offered them home visits and urgent appointments when needed or requested. The practice employed a senior nurse to specifically provide home visiting to frail elderly patients to provide blood pressure check, dementia reviews, flu vaccinations, ear syringing, diabetes reviews and hospital admission avoidance reviews to this population group.
  • All older people had a named GP assigned to them and informed who this was.
  • GP written alerts ensured patient treatment reviews were not missed.
  • A standing agenda item during the palliative care meetings was to discuss frail patients to understand patients that could be deteriorating. These discussions ensured patients in the final year of their life had agreed treatment plans recorded with patients’ wishes.
  • Senior health checks were booked and offered to patients, on an ad hoc basis to maximise the uptake.
  • The premises were wheelchair accessible, there were downstairs clinical rooms and there was a lift to access the first floor clinical rooms.

The branch surgery building was all on one level.

Working age people (including those recently retired and students)

Good

Updated 23 December 2016

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

  • The needs of the working age population, those recently retired and students had been identified at the practice and they had adjusted the services offered to ensure they were accessible, flexible and provided continuity of care.
  • Although the practice did not offer extended hours they did offer on-line services to support working patients and telephone consultations both morning and afternoon. Those that had requested the service received text messages regarding the results of any tests they had received. These telephone details were checked with patients when they received their test to check they were correct.
  • There was a full range of health promotion and patient screening that reflected the needs of this population group.
  • Private employment medicals and insurance reports were available, to support patients that required them for work.

The ability to book on-line appointments and request repeat prescription services gave patients access when needed so they could arrange their time around their health requirements.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 December 2016

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

Mental health quality data from 2015 to 2016 showed, the practice performance was higher than the national and local practice averages for example:

  • 87% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (compared with 76% locally and 78% nationally).
  • 83% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months at the practice, (compared with 73% locally and 72% nationally).

Other services provided by the practice for this population group were

  • Working with multi-disciplinary teams in the case management of patients experiencing poor mental health, and included those with dementia.

  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations such as ‘Health in Mind’ and ‘IAPT’ services.
  • The practice followed up patients who had attended accident and emergency that may have been experiencing poor mental health.
  • Staff had an understanding of how to support patients with mental health needs and dementia.
  • Patients with mental health issues had an appropriate GP written alert placed on their records; this allowed staff members to recognise any extra needs these patients needed.
  • The practice told us they offered patients in this population group on the day appointments to ensure patients in mental health crisis could access a clinician and receive the support they needed.

Practice staff members told us they would find a suitable quiet area for patients to wait if they were feeling anxious, depressed, or too unwell to wait in a busy waiting room.

People whose circumstances may make them vulnerable

Good

Updated 23 December 2016

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

  • The practice clinical members of staff worked with other health care professionals in the case management of vulnerable patients. They worked closely with local care homes to provide, treatment planning, and home visits when needed.
  • The practice had identified 109 patients living in vulnerable circumstances this included those with a learning disability, homeless people or travellers.
  • There were 46 patients identified by the practice as living with a learning disability and they had all been offered an annual assessment and health check. The practice also offered longer appointments for patients with a learning disability.
  • The practice provided information to vulnerable patients about how to access various support groups and voluntary organisations.

Staff knew how to recognise the signs of abuse in vulnerable adults and children. They were aware of their responsibilities concerning the sharing of information and the documentation of safeguarding concerns. The practice safe guarding policy set out the details about how to contact the relevant local agencies during normal working hours and out of hours for staff members.