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The Medical Centre Good Also known as Dr S Laybourn and Partners

Inspection Summary


Overall summary & rating

Good

Updated 5 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Medical Centre at both locations of York Road and Rookwood Avenue on the 12 and 13 July 2016. The overall rating for the practice was good. However, a breach of legal requirements was found, resulting in a rating of requires improvement for the safe domain. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Medical Centre on our website at www.cqc.org.uk.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

  • Regulation 12 HSCA (Regulated Activities) Regulations 2014 Safe care and treatment.

We undertook this focused inspection on 9 March 2017 to check that they had followed their plan and to confirm that the practice now met the legal requirements. This report only covers our findings in relation to those legal requirements.

Our key findings were as follows:

  • The practice had addressed the issues identified during the previous inspection.
  • All staff were aware of the systems in place to effectively manage the safe storage of vaccines and the cold chain procedures.

  • Patient Specific Directions (PSDs) were in place and used by the health care assistants as appropriate. (PSDs are written instructions for medicines to be administered to a named patient after the prescriber has assessed the patient on an individual basis.)

  • The practice could demonstrate what actions they took in respect of national and regional safety alerts.
  • The practice had notified the Care Quality Commission of changes in their registration, for example additional GP partners.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 April 2017

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

The practice had addressed the issues identified during the previous inspection:

  • All staff were aware of the systems in place to effectively manage the safe storage of vaccines and the cold chain procedures.
  • Patient Specific Directions (PSDs) were in place and used by the health care assistants as appropriate.
  • The practice could demonstrate what actions they took in respect of national and regional safety alerts.

Effective

Good

Updated 9 September 2016

The practice is rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. They assessed the needs of patients and delivered care in line with current evidence based guidance.
  • Clinical meetings were held regularly between the GPs to discuss patient care and complex cases. In addition, discussions regarding patients’ care were held between clinicians as needed. Multidisciplinary meetings were held every 12 weeks.
  • Staff worked with other health and social care professionals, such as the community matron, district nursing, health visiting and palliative care teams, to meet the range and complexity of people’s needs.
  • The practice participated in the hospital avoidance scheme by reviewing patients, undertaking care planning and follow-up after post-hospital discharge.
  • End of life care was delivered in a coordinated way.
  • Clinical audits were undertaken and could demonstrate quality improvement.
  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to both local and national figures.
  • The practice was very proactive and supportive with regard to the learning and development of staff. We heard many examples to support this, particularly from the most recently recruited staff.
  • Services were provided to support the needs of the practice population, such as screening and vaccination programmes, health promotion and preventative care.

Caring

Good

Updated 9 September 2016

The practice is rated as good for providing caring services.

  • The practice had a patient-centred culture and we observed that staff treated patients with kindness, dignity, respect and compassion.
  • Data from the national GP patient survey showed that patients rated the practice comparable to other local practices.
  • Patients we spoke with and comments we received were positive about the care and service the practice provided. They told us they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.
  • There was a carers’ register and these patients were offered health reviews, a carers’ pack with information about local carer resources and access to support as needed.
  • We saw there was information available for patients about other services they could access, such as voluntary organisations and support groups. Patients were also signposted as needed by practice staff.

Responsive

Good

Updated 9 September 2016

The practice is rated as good for providing responsive services.

  • The practice worked with Leeds South and East Clinical Commissioning Group (CCG) and other local practices to review the needs of their population.
  • National GP patient survey responses and the majority of comments made by patients said they found it easy to make an appointment.
  • All urgent care patients were seen on the same day as requested.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • A home phlebotomy (blood taking for tests) service was provided for those patients who could not access the practice due to medical reasons.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff.
  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions, including people with a condition other than cancer and people with dementia.

Well-led

Good

Updated 9 September 2016

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

  • There was a clear leadership structure and a vision and strategy to deliver high quality care and promote good outcomes for patients.
  • There were governance arrangements which included monitoring and improving quality, identification of risk, policies and procedures to minimise risk and support delivery of quality care. However, at the time of our inspection the irregularities in the frid

    ge temperatures had not been reported or recorded as a significant event. Consequently, action had not been taken and learning had not occurred, which could have prevented further vaccine fridge temperature anomalies.

  • The provider was aware of and complied with the requirements of the duty of candour.
  • The partners promoted a culture of honesty and integrity and had a comprehensive ‘being open’ policy in place.
  • There were systems in place for being aware of notifiable safety incidents, sharing the information with staff and ensuring appropriate action was taken.
  • Staff were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services. The practice proactively sought feedback from patients through the use of patient surveys, the NHS Friends and Family Test and the patient reference group.
  • We were informed there was a strong culture of learning within the practice. They were a teaching and training practice and had successfully recruited qualified GPs who had previously trained with them as registrars.
  • Although there had been two new GPs join the partnership, the Care Quality Commission had not been notified of these changes in the practice registration.
Checks on specific services

People with long term conditions

Good

Updated 9 September 2016

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

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
  • The practice worked closely with the community matron in the management of housebound patients who had complex long term conditions, to ensure they received the care and support they needed.
  • The practice participated in the Year of Care programme. This approach supported patients to understand their condition and have a more active part in determining their own care and support needs in partnership with clinicians. It was currently being used with all patients who had diabetes, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD).
  • There was a system in place to monitor and review patients who were found to have pre-diabetes.
  • Holistic reviews were undertaken to avoid the need for patients to have multiple appointments
  • 94% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 87%, national average 90%).
  • 71% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG and national averages of 75%).
  • 81% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 88%, national average 90%).

Families, children and young people

Good

Updated 9 September 2016

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

  • Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.
  • The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
  • There was a dedicated child immunisation co-ordinator to promote uptake of all standard childhood immunisations.
  • Cervical screening, sexual health and contraceptive services were provided at the practice.
  • There was a dedicated cervical screening co-ordinator who dealt with the recall and follow up of patients. The latest data showed that 98% of eligible patients had received cervical screening, which was considerably higher than the CCG and national averages of 82%.
  • Appointments were available with both male and female GPs.
  • Reviews were undertaken of children who failed to attend a practice or hospital appointment and those who attended accident and emergency (A&E).

Older people

Good

Updated 9 September 2016

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

  • The practice provided proactive, responsive and personalised care to meet the needs of the older people in its population. Home visits and urgent appointments were available for those patients in need.
  • All elderly patients had a named GP.
  • The practice worked closely with other health and social care professionals, such as the district nursing team, community matron and memory services, to ensure housebound and elderly patients received the care and support they needed.
  • Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission and patients were reviewed as needed.
  • Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.
  • Patients were signposted to other services for access to additional support, particularly for those who were isolated or lonely.

Working age people (including those recently retired and students)

Good

Updated 9 September 2016

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

  • The needs of these patients had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • There was access to text messaging and online services to request repeat prescriptions and make appointments
  • The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. For example, early detection of chronic obstructive pulmonary disease (a disease of the lungs) for patients aged 35 and above who were known to be smokers or ex-smokers.
  • Health checks were offered to patients aged between 40 and 74 who had not seen a 

People experiencing poor mental health (including people with dementia)

Good

Updated 9 September 2016

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

  • The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team. Patients and/or their carer were given information on how to access various support groups and voluntary organisations, such as Mindmate and Carers Leeds.
  • 91% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG and national averages of 88%).
  • 92% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 88%, national average 84%).
  • Staff could demonstrate they had a good understanding of how to support patients with mental health needs or dementia.
  • Those patients who had dementia and did not attend an appointment were contacted by the practice.

People whose circumstances may make them vulnerable

Good

Updated 9 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • Staff 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.
  • There was a register of patients who had a safeguarding concern.
  • The practice could evidence the number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
  • Patients who had a learning disability received an annual review of their health needs and a health action plan was put in place. Carers of these patients were also encouraged to attend, were offered a health review and signposted to other services as needed.
  • There was an alert on the record of those patients who were known to be vulnerable or have complex needs to identify the need for a longer appointment.