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Queensview Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 16 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queensview Medical Centre on 6 October 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.

  • 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.
  • The practice monitored performance using the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). We saw evidence of progress in performance as a result of regular monitoring and improvement work.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • 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:

  • Continue to monitor and ensure improvement to national patient survey results for example access to the practice to book appointments.
  • Continue to monitor performance to ensure that patients with long term conditions receive appropriate monitoring.
  • Complete all outstanding staff appraisals as scheduled and ensure that a system is in place to ensure staff receive regular appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 November 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 learnt were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received support, an explanation of events, and a written apology. They were told about any actions taken 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.
  • The practice maintained effective working relationships with other safeguarding partners such as health visitors.
  • There were appropriate systems in place to protect patients from the risks associated with medicines management and infection control.

Effective

Good

Updated 16 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were largely in line with local and national averages.
  • The practice was an outlier for some areas of QOF for 2014/2015, particularly those relating to diabetes care. We noted that the practice had made efforts to improve performance and evidenced an improvement in QOF performance for the year 2015/2016.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement and the practice informed us that they intended to expand their audit programme as their clinical staffing levels had stabilised.
  • 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. We noted that not all staff had received an appraisal in the 12 months preceding our inspection due to changes in staff. However, all outstanding appraisals were scheduled for completion.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • Clinical staff were aware of the process used at the practice to obtain patient consent and were knowledgeable on the requirements of the Mental Capacity Act (2005).
  • The practice encouraged patients to attend national screening programmes for cervical, breast and bowel cancer.

Caring

Good

Updated 16 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in July 2016 showed patients rated the practice in line with local and national averages 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.
  • The practice had identified 2% of patients as carers and was continuing to identify and support carers within their population.

Responsive

Good

Updated 16 November 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 NHS Nene Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice offered a range of enhanced services including avoiding unplanned admissions to hospital and minor surgery.
  • Patients said they were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • Two GPs were trained to provide extended scope cardiology services, allowing them to liaise directly with the community cardiology service resulting in a fast track service for patients at risk of heart failure. These GPs were able to make direct access appointments for patients to have tests undertaken at the local hospital, receive the results and initiate appropriate treatment as needed. This reduced the need for referrals and ensured that patients received faster intervention and treatment when needed.
  • Two GPs were able to offer dermatoscope examinations (a dermatoscope is a magnifying tool used to examine skin lesions) further reducing pressures on secondary care referrals.
  • 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 and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • A phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital.

Well-led

Good

Updated 16 November 2016

  • The practice had a clear vision to deliver high quality health care in a responsive, supportive, courteous and cost effective manner with equality for all patients as a focus.

  • 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 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 practice was engaged with the patient participation group (PPG) and encouraged them to provide feedback on areas of improvement.
  • We saw evidence that the practice had gone through a period of staff change and organisational transformation. We saw that there was a focus on continuous learning and improvement at all levels to ensure the future sustainability of the practice.
Checks on specific services

People with long term conditions

Good

Updated 16 November 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.
  • Performance for diabetes related indicators was below the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 64%, where the CCG average was 82% and the national average was 81%. We saw that the practice had been proactive in improving performance and services provided for patients with diabetes. The practice provided unpublished data 2015/2016 which demonstrated a marked improvement in the practice’s QOF performance.
  • The percentage of patients with asthma, on the register, who had received an asthma review in the preceding 12 months that included an assessment of asthma control, was 66% where the CCG average was 75% and the national average was 75%.
  • 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 16 November 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 may be 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, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 76%, which was comparable to the CCG average and national averages 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.
  • Family planning and contraceptive advice was available.

Older people

Good

Updated 16 November 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 supported registered frail elderly patients in local nursing homes.
  • The practice provided influenza, pneumonia and shingles vaccinations.
  • A phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital.
  • The practice offered health checks for patients over the age of 75.
  • All patients over the age of 75 had a named GP, personalised care plans and priority access to GP care if needed.
  • The district nursing team were based within the practice and we saw evidence that this ensured good standards of communication between the services and ensured patients received a multi-disciplinary package of care.

Working age people (including those recently retired and students)

Good

Updated 16 November 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 provided health checks to all new patients and carried out routine NHS health checks for patients aged 40-74 years. At the time of our inspection for the period June 2012 to October 2016 the practice had completed 381 of 2,271 (17%) eligible health checks for people aged 40 to 74 years. The practice had recently recruited a Health Care Assistant (HCA) and we were told of plans for the HCA to undertake health checks for both newly registered patients and NHS health checks for patients aged 40 – 74 years.
  • Extended pre-bookable appointments were available from 6.30pm till 8pm on Thursdays and from 7am on Fridays.
  • Telephone consultations were available daily.
  • The practice had enrolled in the Electronic Prescribing Service (EPS) in April 2016. This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 November 2016

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

  • The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 76% where the CCG average was 85% and the national average was 84%.
  • The practice maintained a register of patients with mental health concerns and all were invited to attend annual reviews.
  • Performance for mental health related indicators were comparable to local and national averages. For example, with diagnosed psychoses who had a comprehensive agreed care plan was 79% where the Clinical Commissioning Group (CCG) average was 91% and the national average was 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended A&E 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.

People whose circumstances may make them vulnerable

Good

Updated 16 November 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 treatment room nurse was a trained learning disability nurse able to provide dedicated support to patients, including annual reviews of their health. At the time of our inspection 47 patients were under her care of which 32 (68%) had received an annual review in the 12 months preceding our inspection.
  • 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 worked in liaison with the CCG Collaborative Care Team (CCT) to provide support to vulnerable patients with complex health and social needs.
  • The practice informed vulnerable patients about how to access support groups and voluntary organisations.
  • The practice held palliative care meetings involving district nurses, GP’s and other local support organisations.
  • The practice provided a dedicated telephone number for deaf patients, enabling them to arrange appointments via SMS text messages.
  • 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 had identified 170 patients (2% of the practice list) as carers. The practice was making continued efforts to identify and support carers in their population.