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Gleadless Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 11 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gleadless Medical Centre on 21 June 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed with the exception of the frequency of basic life support training and the recording of the immunity status of clinical staff.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. The practice actively reviewed complaints and improvements were made to the quality of care as a result of complaints, concerns and patient feedback.
  • Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day through the GP telephone consultation system.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

  • The clinical staff produced a specific individual care plan for patients who had long term conditions, for example, diabetes at the end of the consultation or annual review. This included clinical information such as cholesterol, blood pressure and blood glucose levels. It calculated the patient’s risk of cardiovascular disease and explained what this meant to them personally. It included medication information and an action plan of ways to control their condition. There was space at the back of the form for patients to write down things they wanted to discuss at their next appointment. Staff told us this gave the patient time to reflect on the results and the agreed treatment plan and encouraged patients to be more proactive in managing their condition.

The areas where the provider should make improvements are:

  • Complete carpet and curtain cleaning every six months as specified in NHS National Patient Safety Agency specification guidance for cleanliness in primary care premises.

  • Complete basic life support training more frequently for both clinical and non clinical staff as specified in the resuscitation council (UK) guidelines for staff working in primary care.

  • Maintain a complete record of the immunity status of clinical staff as specified in the practice’s own Occupational Health policy and in the national Green Book (immunisations against infectious disease) guidance for healthcare staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and mostly well managed with the exception of the frequency of basic life support training and carpet and curtain cleaning.

Effective

Good

Updated 11 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • The clinical staff produced a specific individual care plan for patients at the end of the consultation or annual review. This included clinical information such as cholesterol, blood pressure and blood glucose levels. It calculated the patient’s risk of cardiovascular disease and explained what this meant to them personally. It included medication information and an action plan of ways to control their condition. There was space at the back of the form for patients to write down things they wanted to discuss at their next appointment. Staff told us this gave the patient time to reflect on the results and the agreed treatment plan and encouraged patients to be more proactive in managing their condition.

Caring

Good

Updated 11 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect and maintained patient and information confidentiality.

Responsive

Good

Updated 11 August 2016

The practice is rated as outstanding for providing responsive services.

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

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day through the GP telephone consultation system.

  • The practice offered an online e-consultation service where patients could email the practice for non urgent advice and receive a response within 48 hours.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. 

  • The practice actively promoted services and provided patients with up to date information on their social media website page. For example, the practice had assured patients of practice safety systems when the recent cholesterol lowering medication alert had been in the press and we saw the GPs responded to all comments, complaints and suggestions on the site.

  • The practice had a very effective system in place for handling complaints and concerns and encouraged patients to feedback their comments either through the practice's online social media page or on a form available in reception. Evidence showed the practice responded quickly to any complaints, comments or feedback raised. Learning from complaints and comments was shared with staff and other stakeholders. 

  • The practice had developed a virtual ward round.This was a real time log of patients who were in hospital or who had recently been discharged. The practice was then able to monitor their follow up care. For example, we observed a patient discharged the day before had been contacted by the practice and an appointment made to review their respiratory condition and care plan. The GPs met weekly with the district nurses to discuss these patients. The practice also used this information to identify patients who had multiple in-patient stays who may be vulnerable or require extra support. The practice had identified five such patients in the past 12 months who were then included on the unplanned admissions register to be monitored more frequently.

Well-led

Good

Updated 11 August 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 were clear about the vision and their responsibilities in relation to it.

  • 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 meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk with the exception of maintaining a complete record of clinical staffs’ immunity status as outlined in their own occupational health policy.

  • The registered provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 11 August 2016

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

  • Nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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 clinical staff produced a specific individual care plan for patients who had long term conditions, for example, diabetes at the end of the consultation or annual review.

Families, children and young people

Good

Updated 11 August 2016

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 who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • QOF data showed 90% of women eligible for a cervical screening test had received one in the previous five years compared to the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 11 August 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.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice provided medical care and weekly routine GP visits to patients who resided in two local care homes.

  • The percentage of patients aged 65 or over who received a seasonal flu vaccination was 81%, higher than the national average of 73%.

Working age people (including those recently retired and students)

Good

Updated 11 August 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 and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

  • The practice offered evening appointments on a Wednesday at the practice and weekend and evening appointments at a local practice through the Sheffield satellite clinical scheme.

  • The practice offered appointments with an occupational health adviser and was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 August 2016

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

  • Of those patients diagnosed with a mental health condition, 85% had a comprehensive care plan reviewed in the last 12 months, which is comparable to the national average of 88%.

  • Of those patients diagnosed with dementia, 76% had received a face to face review of their care in the last 12 months, which is lower than the national average of 84%.

  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • The practice 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.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice hosted Improving Access to Psychological Therapies Programme (IAPT), a counselling service to support patients’ needs.

People whose circumstances may make them vulnerable

Good

Updated 11 August 2016

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 those with a learning disability.

  • 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 developed a virtual ward round.This was a real time log of patients who were in hospital or who had recently been discharged. The practice was then able to monitor their follow up care. For example, we observed a patient discharged the day before had been contacted by the practice and an appointment made to review their respiratory condition and care plan. The GPs met weekly with the district nurses to discuss these patients. The practice also used this information to identify patients who had multiple in-patient stays who may be vulnerable or require extra support. The practice had identified five such patients in the past 12 months who were then included on the unplanned admissions register to be monitored more frequently.

  • The practice hosted a community support worker who would advise and signpost patients to services. For example, information on housing and social care or support to join local social activities.
  • The practice informed 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. 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.