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Granville House Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Granville House Medical Centre on 8th December 2016.

Overall the practice is rated as good.

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

  • There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, staff were trained to manage medical emergencies and procedures were in place to promote infection control.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • Staff felt well supported. They had access to training and development opportunities and had received training appropriate to their roles.

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

  • Services were planned and delivered to take into account the needs of different patient groups.

  • Access to the service was monitored to ensure it met the needs of patients.

  • Information about how to complain was available. There was a system in place to manage complaints.

  • There were systems in place to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

  • Put a system in place to record the action taken following the receipt of patient safety alerts.

  • Ensure a daily record is made of the temperature readings for vaccine fridges.

  • Staff recruitment records should contain evidence of information having been gathered about any physical or mental conditions which were relevant (after reasonable adjustments) to the role the person was being employed to undertake.
  • Maintain a central record of all clinical training undertaken by staff to assist with monitoring their training needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 January 2017

The practice is rated as good for providing safe services. Safety events were reported, investigated and action taken to reduce the chance of a re-occurrence. There were appropriate systems in place to ensure that equipment was safe to use. There were systems to protect patients from the risks associated with insufficient staffing levels, medicines management and infection control. Staff were aware of procedures for safeguarding patients from the risk of abuse. We found that improvements should be made to the records relating to staff recruitment, patient safety alerts and to the daily recording of fridge temperatures.

Effective

Good

Updated 30 January 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 had

access to training and development opportunities and had received training appropriate to their roles

.

A c

entral record of all clinical training undertaken by staff should be maintained to assist with monitoring their training needs.

Caring

Good

Updated 30 January 2017

The practice is rated as good for providing caring services. We saw that staff treated patients with kindness and respect. Patients spoken with and who returned comment cards were positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful. Patients felt involved in planning and making decisions about their care and treatment.

Responsive

Good

Updated 30 January 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 clear guidance about how to handle a complaint.

Well-led

Good

Updated 30 January 2017

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. The practice proactively sought feedback from staff and patients, which it acted on.

Checks on specific services

People with long term conditions

Good

Updated 30 January 2017

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The practice aimed to ensure that patients were able to see one nurse for all of their long term conditions to reduce the need for multiple appointments. The practice offered patients access to their care records and they were promoting this to patients with a long term condition. This encouraged patients to manage their conditions and may improve patients’ health by providing self-care tools. The nursing team took the lead for different long term conditions and kept up to date in their specialist areas. They made home visits to carry out blood tests where patients were unable to visit the practice. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Families, children and young people

Good

Updated 30 January 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Childhood immunisation rates for the vaccinations given were comparable to local and in some instances above national averages. Priority was given to young children who needed to see the GP and appointments were available outside of school hours. The GPs liaised with other health care professionals, such as health visitors to ensure the needs of vulnerable children were addressed. Accident and emergency attendances were monitored. The practice had recently met with the local authority domestic violence team to gain a clearer understanding of their role and the issues faced by some families.

Older people

Good

Updated 30 January 2017

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

The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles.

Each patient had a named GP to ensure continuity of care.

The practice provided services to two local care homes. V

isits were carried out by the same clinicians where possible to provide continuity. This service had led to better co-ordination of patient care and had assisted with avoiding unplanned admissions to hospital. A system was in place to ensure the needs of older patients’ discharged from hospital were reviewed in a timely manner and care plans were drawn up to support their care and treatment. The

practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.

Working age people (including those recently retired and students)

Good

Updated 30 January 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 6.30pm Monday to Friday. The appointment system provided pre-bookable and on the day appointments, where every patient who contacted the practice before 10.30am was offered an appointment that day. Patients could book appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice. Appointments could be booked up to two weeks in advance. Telephone consultations were also offered. A text messaging service reminded patients about their appointments, requested information from patients to assist in their care such as up to date blood pressure readings and reminded patients about services provided such as the flu vaccination. An extended hour’s service for routine appointments was provided on two Saturdays a month from 8.30am to 11.30am.

The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, smoking cessation advice and family planning services. Reception staff sign-posted patients who did not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP). In-house phlebotomy and cryotherapy services were provided which meant patients could receive these services locally rather than having to travel to another service.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. Longer appointments were also offered. 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 psychiatry and counselling services. The staff team had received training in dementia awareness to assist them in identifying patients who may need extra support. Staff had also received training in the Mental capacity Act 2005.

People whose circumstances may make them vulnerable

Good

Updated 30 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example,

if a patient had a learning disability to enable appropriate support to be provided. There was a recall system to ensure patients with a learning disability received an annual health check.

The practice prioritised patients who may be at risk of poor health due to vulnerability and had care plans in place to support these patients. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and children and all staff had safeguarding training relevant to their role.

Se

rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. Members of staff acted as carer’s links and they were working to identify carers and promote the support available to them through organisations such as N-Compass Carers Services. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the Lancashire Well-being Service for support with social issues that were having a detrimental impact upon their lives