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Drs Eno and Partners Good Also known as Trinity Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Shah and Partners, also known as Trinity Medical Centre name on 20 March 2017. 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 a system in place for reporting and recording significant events which staff understood.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance.
  • Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect although the figure for being involved in decisions about their care and treatment was below the local and national average for GPs.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

  • Ensure systems to ensure patient group directives are signed by the same designated person.

  • Ensure care plans for patients with asthma contain all the required information, including what the patient should do in the event of an emergency.

  • Develop a schedule of audit in relation to patients’ health and treatment needs rather than those required by the Clinical Commissioning Group.

  • Record verbal complaints to include actions taken.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 April 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system 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 were informed as soon as practicable, 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 to minimise risks to patient safety.

  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 28 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

  • Staff were aware of and followed current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge 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.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 28 April 2017

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.

  • Survey information we reviewed showed that 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 accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 28 April 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example they invited the specialist diabetic nurse to attend the practice to review patients and one of the GPs provided ear, nose and throat appointments at the practice.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • Patients we spoke with 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 evidence from five examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. Verbal complaints were not recorded, but dealt with at the time.

Well-led

Good

Updated 28 April 2017

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 policies and procedures to govern activity and held regular governance meetings.

  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour. In four examples we reviewed we saw evidence the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.

  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.

Checks on specific services

People with long term conditions

Good

Updated 28 April 2017

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • Overall, performance for diabetes related indicators was below the CCG and national average. The practice were aware of this and had developed an action plan to improve. This included changing their recall system, the diabetic specialist nurse attended to support the practice nurses and recruiting a GP with special interest in diabetes. Their exception reporting rate overall for diabetes indicators was 6% compared to a CCG average of 8% and national average of 12%. The practice held specialist diabetic reviews for patients with complex diabetes.

  • The practice followed up when patients with long-term conditions were discharged from hospital and ensured that their care plans were updated to reflect any changes to their needs.

All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met through the local PACT (Put All Care Together) system which offered a 45 minute appointment where goals were identified and agreed. For those patients with the most 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 28 April 2017

The practice is rated as good for the care of families, children and young people.

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency 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.

  • Appointments were available outside of school hours and in response to identified need, the practice offered a dedicated children’s clinic three times a week. The premises were suitable for children and babies.

  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, providing ante-natal, post-natal and child health surveillance clinics.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 28 April 2017

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

  • Staff were able to recognise the signs of abuse in older patients and understood their responsibility to report any concerns.

  • The practice offered proactive and personalised care to meet the needs of the older patients in its population. One GP was assigned to triage home visits for patients who rang requesting these.

  • The practice was responsive to the needs of older patients, they offered home visits and urgent appointments for those with enhanced needs.

  • The practice identified older patients who may need palliative care as they were approaching the end of life. They involved older patients and their relatives and carers where relevant in planning and making decisions about their care, including their end of life care.

  • The practice followed up when older patients were discharged from hospital and ensured any care plans were updated to reflect any changes in needs.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 28 April 2017

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

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure they were accessible, flexible and offered continuity of care, for example, extended opening hours three evenings a week and Saturday appointments.

  • The practice was proactive in offering online services for booking appointments and repeat medicines requests as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice saw students who left the area to attend university as temporary patients when they returned home for holidays.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 April 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • 84% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average 90% and national average of 84%.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice specifically considered the physical health needs of patients with poor mental health and dementia and worked with local specialist services to ensure joined up care and treatment.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • The practice had 127 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 88% of these patients, compared to a CCG average of 90% and national average of 89%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 28 April 2017

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.

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

  • 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 had information displayed for vulnerable patients about how to access various support groups and voluntary organisations and clinical staff gave relevant leaflets during consultations.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.