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Churchside Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 2 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced focussed follow up inspection on 24 October 2016 to follow up on concerns we found at Dr Ward, Pearce and Partners on 30 November 2015. This inspection was to ensure that improvement had been made following our inspection in November 2015 when breaches of regulations had been identified. The inspection in November 2015 found breaches of regulation and rated the practice as good overall but requires improvement in safe services.

At the inspection on 24 October 2016 we found that overall the practice had implemented changes and that the service was meeting the requirements of the regulations. The ratings for the practice have been updated to reflect our findings following the improvements made since our last inspection in November 2015. The practice is now rated as good for safe services.

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

  • The practice had reviewed protocols and processes involving cold chain recording and reporting and maintain an audit trail of prescription stationery.

  • The practice had undertaken a CoSHH assessment and risk assessment in respect of liquid nitrogen.

  • The practice had reviewed its complaints systems to provide a complete audit trail of outcomes.

  • Reviewed it systems to make sure staff were aware of training expiry dates and ensured the training the practice considered to be mandatory was completed as needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 December 2016

The practice is now rated as good for providing safe services.

Our last inspection in November 2015 identified concerns relating to the cold chain protocol, prescription security and risk assessments for the liquid nitrogen.

At this inspection we saw the concerns had been addressed:

.

  • The practice had an effective practice specific protocol for the cold chain.

  • Prescription security had been strengthened and the practice were recording and tracking the blank prescriptions.

  • There was a risk assessment in place for the liquid nitrogen.

  • The complaints process had been strengthened to provide an audit trail of outcomes and the process for ensuring training was completed had been revised.

Effective

Good

Caring

Good

Responsive

Good

Well-led

Good
Checks on specific services

People with long term conditions

Good

Updated 24 May 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. The Practice had 310 patients with a diagnosis of diabetes on their register and had achieved 88% of the available QOF points for diabetes related indicators. This was 6.4% above the CCG average and slightly below the national average.
  • Patients with long term conditions received reminders linked to their birthday for annual reviews and were recalled every six monthly for interim and medicines reviews.
  • Longer appointments and home visits were available when needed. All patients had a named GP and for patients with the most complex needs; the named GP worked with the multidisciplinary team, community matron, and specialist nurses to deliver a multidisciplinary package of care.
  • Additional services were offered for patients with a diagnosis of rheumatoid arthritis and treatments available included in-house acupuncture and joint injections.
  • There was good information and educational links on the practice website in respect of long-term conditions, providing patients with information on conditions including diabetes and asthma.

Families, children and young people

Good

Updated 24 May 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 above 90% for all standard childhood immunisations and childhood seasonal influenza vaccinations were offered.
  • Appointments were available outside of school hours until 8pm on a Thursday and the premises were suitable for children and babies.
  • The community midwife offered maternity services from the practice two days per week.
  • The practice website had good links to family health, covering children’s health 0-5yrs and 6-15yrs signposting patients to other websites for further information.
  • Additional clinics were held for teenage females and patients who were pregnant.

Older people

Good

Updated 24 May 2016

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

  • The practice carried out routine and emergency GP and nursing home visits for housebound patients and during the influenza season offered appointments to receive the vaccination and also provided Saturday clinics to enable working carers to bring patients to the practice.
  • 18% of the practice list were over 65 and 9% over 75 years old.
  • Patients over 65 were prioritised for receiving pneumonia and shingles vaccinations, and were signposted to various different services both within the NHS and voluntary sector organisations to meet and support their needs and to try to prevent unplanned admissions.
  • The practice participated in Profile Risk Integrated Care & Self-Management (PRISM) multidisciplinary team meetings, with the aim of avoiding unplanned admission into hospital. They also used the Devon Tool, which is a risk assessment tool to identify patients at 70+% risk of unplanned admission.
  • All patients over 75 and over had a named GP. An area on the practice website was specifically set up for older people, informing patients about seasonal flu vaccinations, guidance and factsheets. In addition older people were also able to access information on eating well and exercise.

Working age people (including those recently retired and students)

Good

Updated 24 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice offered NHS health checks, cervical screening and chlamydia testing in order to provide early diagnosis and treatment.
  • They offered an in-house smoking cessation service, weekly weight management class and HGV/Taxi /Armed Forces medicals.
  • The practice offered an online appointment booking and prescription ordering system and the surgery was open until 8pm on a Thursday evening in order to book routine GP and nurse appointments.
  • Meningococcal awareness and vaccines were available for all 18 year old patients and new university students.
  • 80.9% of eligible women had received cervical screening in the preceding 5 years. (CCG average was 76.5% and national average was 81.8%).

People experiencing poor mental health (including people with dementia)

Good

Updated 24 May 2016

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

  • 95% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which was 11% above the CCG and England average achieved with no exception reporting.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia
  • Patients experiencing received reminders linked to their birthday for annual reviews and were recalled every six monthly for interim and medicines reviews.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and referred patients to a local memory clinic if applicable.
  • Weekly blister packs were used to help patients with Dementia take the right medicine at the right time. Screening tools were used for patients with suspected dementia and depression to help diagnose and identify needs and risks.
  • All clinical and administrative staff had undergone dementia awareness training. Staff had a good understanding of how to support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 24 May 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.
  • It offered longer appointments for people with a learning disability and used pictured letters as a form of communication for patients with learning difficulties.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Vulnerable patients were given information about how to access various support groups and voluntary organisations. The practice offered annual learning disability review appointments with a GP and practice nurse.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children and 90% of staff were trained to care identify and support women experiencing domestic violence .
  • 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.