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Lowfield Medical Centre Good Also known as Lowfield Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 11 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Lawrence and partners on 10 May 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 for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Emergency medicine was checked regularly, however, the hypodermic needles in the emergency kit were out of date. These were replaced during the inspection and included in the list of checks to be carried out.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns, however, verbal complaints were not recorded at the practice.
  • Patients said there were appointments available, but that getting through to the practice on the telephone could be difficult. There was continuity of care, with urgent appointments available the same day.
  • 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.

The areas where the provider should make improvement are:

  • Review how patients access appointments by telephone.
  • Review the process to record verbal complaints.
  • Continue to build their Carers register and to increase awareness of support available wherever possible.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice


Inspection areas

Safe

Good

Updated 11 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system 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 to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.
  • Emergency medicines was checked regularly, however, the hypodermic needles in the emergency kit were out of date. These were replaced during the inspection and included in the list of checks to be carried out.

Effective

Good

Updated 11 July 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.

Caring

Good

Updated 11 July 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 July 2016

The practice is rated as good for providing responsive services.

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

  • Patients said that appointments were available but that getting through to the practice on the telephone was sometimes difficult. The practice was aware of this and had trialled different schemes to address the issue. They were promoting online services with the support of the patient participation group.

  • Patients said there was continuity of care, with urgent appointments available the same day

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

  • Information about how to complain was available and easy to understand. However, verbal complaints were not recorded at the practice. Evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 11 July 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.

  • The 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 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 July 2016

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

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 79% compared to 78% within the Clinical Commissioning Group (CCG) and 81% at national average.

  • 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 practice provided a dedicated respiratory disease nurse who held a clinic once each week for patients with chronic breathing problems.

  • The practice provided a GP led insulin initiation and monitoring clinic for patients newly diagnosed with diabetes.

Families, children and young people

Good

Updated 11 July 2016

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

  • 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.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 82% compared to 87% within the clinical commissioning group (CCG) and 82% as a national average.

  • 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, health visitors and school nurses.

  • Staff told us that the practice sent a letter congratulating families on their new baby/babies and attached a post-natal and a first immunisation appointment with this.

  • Ante-natal whooping cough vaccine was offered to women who were 28 weeks plus into their pregnancy to help protect their unborn child/children.

Older people

Good

Updated 11 July 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 patient 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 held a list of patients unable to leave the house and ensured they had access to repeat prescriptions over the telephone.

  • Polypharmacy reviews were carried out for older patients between three and twelve monthly.

Working age people (including those recently retired and students)

Good

Updated 11 July 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 help ensure these were accessible, flexible and offered continuity of care.

  • 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.

  • The practice provided travel vaccinations and was a Yellow Fever designated centre.

  • University students who returned during holiday periods were seen as temporary patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 July 2016

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

  • 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is the same as the national average.
  • 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months which is better than the national average of 90%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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.
  • Staff had a good understanding of the Mental Capacity Act and best interests’ decision making.

People whose circumstances may make them vulnerable

Good

Updated 11 July 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 homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability or complex needs.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • 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.
  • The practice visited residential homes for people living with dementia and those with a learning disability. Medication for these patients was reviewed on admission to the care home and then on a six monthly basis.