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Churchside Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 24 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ward Pearce and Partner on 30 November 2015. Overall the practice is rated as good.

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

  • There was an open culture in respect of learning from incidents and a commitment to preventing similar events occurring in future.
  • Some risks were managed well but systems needed strengthening in some areas such as ensuring the cold chain protocol was understood and followed, recording the numbers of prescription stationery and risk assessing liquid nitrogen.
  • Staff showed a commitment to using NICE guidelines and to improving outcomes for patients. Where they identified issues there were plans in place to address these.
  • Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment and this was supported by the national patient survey data which rated the practice above others in the CCG in a number of areas.
  • Information about services and how to complain was available and easy to understand but outcomes were not clearly recorded to provide a clear oversight of trends..
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. Patient survey data showed the practice performed well in respect of patients being able to access appointments when needed.
  • 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 but some felt communication could be clearer and more frequent.

We saw one area of outstanding practice:

  • One member of staff ran a weight management classes for local patients. Giving up their own time, they tailored weekly classes to match the students’ needs and provided the training program over twelve weeks. This would be attended by between two and 20 patients each week. Patient feedback indicated they valued this support, even if their weight loss was not substantial and they found the education around healthy eating to be valuable.

The areas where the provider should make improvement are:

  • Review protocols and processes involving cold chain recording and reporting and maintain an audit trail of prescription stationery
  • Undertake a CoSHH assessment and risk assessment in respect of liquid nitrogen.
  • Review complaints systems to provide a complete audit trail of outcomes.
  • Review systems to make sure staff are aware of training expiry dates and ensure training the practice considers to be mandatory is 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

Updated 24 May 2016

The practice is rated as good for providing effective services.

  • Staff showed a commitment to using NICE guidelines and to improving outcomes for patients. Data showed they had achieved
  • The practice engaged with local outside agencies to ensure the more vulnerable patients had access to treatment.
  • Clinical audits demonstrated quality improvement and resulted in positive outcomes for patients.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There were personal development plans for all staff.
  • We saw evidence of effective multidisciplinary teams working together to understand and meet the range and complexity of people’s needs.
  • One member of staff ran a weight management classes for local patients. Giving up their own time, they tailored weekly classes to match the students’ needs and provided the training program over twelve weeks. This would be attended by between two and 20 patients each week. Patient feedback indicated they valued this support, even if their weight loss was not substantial and they found the education around healthy eating to be valuable.

Caring

Good

Updated 24 May 2016

The practice is rated as good for providing caring services.

  • Results from the latest GP patient survey in July 2015 showed that patients were treated with compassion, dignity and respect: for example 89.9% of patients felt the GP was good at involving them in decisions about their care in comparison to the CCG average of 78.7% and the national average of 81.4%.
  • 91.5% of patients said the GP was good at explaining tests and treatments compared to CCG average of 83.1% and national average of 86%.
  • The practice website was comprehensive and very informative for patients about the services available; it was easy to navigate, understand and was easily accessible.
  • During our inspection we observed that staff treated patients with kindness and respect, and maintained confidentiality.
  • The practice had a carer’s list and had identified 2% of their patient list as having caring responsibilities. There was information on display in the practice and a proactive approach to identify carers at registration and when flu vaccinations were provided. One of the GPs was the carer’s lead for the practice and we saw evidence to show they had undertaken training to help them undertake this role.

Responsive

Good

Updated 24 May 2016

The practice is rated as good for providing responsive services.

  • It was aware of the needs of its local population and engaged with the Nottinghamshire County Council Public Health, NHS UK and local clinical commissioning group (CCG) to secure improvements to services where these were identified. For example the practice provided extended hours and had operated Saturday influenza clinics to provide more flexibility for patients who worked.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. National patient survey results confirmed these views. 84.9% of patients were satisfied with the practice’s opening hours compared to the CCG average of 77.6% and national average of 74.9%.
  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. Information on how to complain was clearly visible to patients around the practice, however the complaints investigations we reviewed did not detail the outcome and the audit trail of actions would benefit from strengthening.

Well-led

Good

Updated 24 May 2016

The practice is rated as good for being well-led.

  • The practice had a vision and strategy. Staff were clear about this and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported in general by management, however some staff members expressed concerns that communication and support within the practice could be improved at all levels.
  • Staff were appointed as lead team members for specific areas and tasks and all staff were aware of this and could highlight who was responsible for each area.
  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which included arrangements to monitor and improve quality and identify risk.
  • The practice sought feedback from staff and patients. The patient participation group (PPG) was active and told us they aimed to improve attendance and interaction from GPs.
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.