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Earle Road Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 20 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Earle Road Medical Centre on 19 April 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.
  • 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.

There were areas of outstanding practice as follows:

  • The practice is based in a deprived area of Liverpool with a substantial bBME) patient profile. The practice team including the trainee doctors have been working hard to improve access for this population group, particularly in areas where there was poor uptake such as access to cervical screening and children’s immunisations. The practice was aware that some members of these communities were unaware of services available at the GP practice. To improve access they set up links with a local community centre and Liverpool CCG to provide health promotion and education sessions within the centre for females from the BME communities. Education workshops were held in the centre run by the practice team focusing on women’s health and well being covering topics such as childhood immunisation, women’s health, heart disease, cervical smears and diabetes. The practice advised that this work had

The areas where the provider should make improvement are:

.

  • The practice should provide written information in different languages to meet the profile of the patient population

  • The provider should ensure that information is held for locum GPs including documentary evidence of their professional registrations, fitness to practice and records of their completed training.

  • The provider should ensure full and completed minutes are kept for all multi disciplinary meetings taking place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 June 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 well managed.

Effective

Good

Updated 20 June 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 20 June 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 20 June 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 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.

  • 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.

Well-led

Good

Updated 20 June 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 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 20 June 2016

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. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

  • The GPs had lead roles in chronic diseases and practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health. Patients with several long term conditions were offered a single, longer appointment to avoid multiple visits to the surgery.

  • Data from 2014 to 2015 showed that the practice was comparable with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had influenza immunisation was 96% compared to a national average of 94%.

  • Longer appointments and home visits were available for patients with long term conditions when these were required.

  • The practice contacted patients following admission to hospital to check if they required any services from the practice.

  • The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

Families, children and young people

Good

Updated 20 June 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 those who were at risk, for example, children and young people who had a high number of A&E attendances. A GP was the designated lead for child protection.

  • Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

  • Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations. The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

  • The practice worked with local community groups to encourage patients from a BME background to improve their access to primary care services, including childhood vaccinations.

  • Appointments were available outside of school hours.

  • The premises were suitable for children and babies and baby changing facilities were available.

  • Family planning services were provided and the practice had a lead for sexual health and contraception.

Older people

Good

Updated 20 June 2016

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

  • The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

  • The practice provided a range of enhanced services, for example, the provision of care plans for patients over the age of 75 and screening patients for dementia.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages.

  • GPs carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions.

  • Home visits and urgent appointments were provided for patients with enhanced needs.

  • The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

  • The GPs held special interests in conditions commonly found in older people and there was a designated GP lead for the care of patients over 75 years of age.

  • Staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

Working age people (including those recently retired and students)

Good

Updated 20 June 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.

  • Telephone consultations were available and this meant patients did not always have to attend the practice in person.

  • The practice had extended opening hours on a Wednesday evening until 8.30pm.

  • The practice provided a full range of health promotion and screening that reflected the needs of this age group.

  • The practice was proactive in offering online services including the booking of appointments and request for repeat prescriptions. Electronic prescribing was also provided.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 June 2016

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

  • Data about how people with mental health needs were supported showed that outcomes for patients using this practice were similar to or better than average. For example, data showed that 93% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a national average of 84.%.

  • The practice provided an enhanced service for screening patients to identify patients at risk of dementia and to develop care plans with them.

  • Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

  • Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they took.

  • Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 20 June 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 in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these. Patients spoke positively about the GPs attendance at these annual reviews.

  • The practice provided primary care to people who have a learning disability who were living in a local care home.

  • 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 was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

  • Information and advice was available about how to access a range of support groups and voluntary organisations.