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The Range Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 11 April 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Range Medical Centre on the 24 November 2016. At the inspection in November 2016 the overall rating for the practice was good, although the key question safe was rated requires improvement. We found improvements were needed in relation to staff recruitment, systems to monitor expiry dates of vaccines, information governance in relation to locum staff and the management of some risks in relation to Control of Substances Hazardous to Health (COSHH) regulations. In addition we identified that not all staff files demonstrated evidence that an induction had been completed.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for The Range Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on the 16 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the two breaches in regulation that we identified in our previous inspection on 24 November 2016. This report covers our findings in relation to those requirements.

The practice is now rated good for all key questions and the overall rating remains good.

Our key findings were as follows:

  • At our previous inspection in November 2016 we found some staff files did not contain all the required recruitment documentation. The practice supplied evidence to demonstrate all staff recruitment files had been reviewed and a matrix of records held for each staff member was established.
  • The practice had introduced induction training record sheets for both clinical and non clinical staff and completed copies of these for both a GP and non clinical staff member were provided to demonstrate their use.
  • Systems had also improved to ensure locum GPs had specific logins and passwords to use on the patient electronic record system.
  • Data sheets were now available at the practice for all substances such as cleaning agents used at the practice. This ensured compliance with COSHH regulations.
  • At the previous inspection in November 2016 we noted six vaccines, held in one of the practice’s vaccines fridges had passed their expiry date. The practice had reviewed their policy on the monitoring of vaccines and had improved how expired vaccines were disposed of. Records supplied demonstrated the practice’s policy was implemented appropriately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 April 2018

Effective

Good

Updated 3 February 2017

The practice is rated as good for providing effective services.

  • 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.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

  • The practice had an induction programme for all newly appointed staff. It covered such topics as safeguarding, infection prevention and control, fire safety and confidentiality. However, there was no evidence of staff undertaking induction in their personnel files.

Caring

Good

Updated 3 February 2017

The practice is rated as good for providing caring services.

  • 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 confidentiality.
  • Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect.
  • The practice’s computer system alerted GPs if a patient was also a carer.

Responsive

Good

Updated 3 February 2017

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.
  • 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. The practice had undertaken a comprehensive analysis of the complaints to identify and share learning opportunities and trends.

Well-led

Good

Updated 3 February 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 this.
  • The practice did not have a documented succession plan for the practice to include such eventualities as the retirement of GPs.
  • 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. However, the policies were not always available to locum GP staff.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care.
  • 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 knowing about 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.
Checks on specific services

People with long term conditions

Good

Updated 3 February 2017

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.
  • Patients with diabetes whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 77% compared to the national average of 81%.
  • 83% of patients with diabetes had received an influenza immunisation compared to the national average of 94%.
  • The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months was 66% compared to the national average of 78%.
  • A record of foot examination was present for 80% of patients compared to the national average of 88%.
  • Patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 70% compared to the national average of 78%.
  • The percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 84%, compared to the national average of 84%.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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 3 February 2017

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.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2015 to 31/03/2016) was 71%, which was significantly below the national average of 81%. The practice had recognised the low figures and had produced a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 60% to 96% and five year olds from 65% to 93%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 3 February 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • All elderly patients had been informed of their named GP.
  • The practice offered same day appointments as well as telephone consultations.

Working age people (including those recently retired and students)

Good

Updated 3 February 2017

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.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • Telephone appointments were available if patients wished to discuss test results and urgent concerns and for those who may have difficulty attending surgery due to work commitments.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 February 2017

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

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advanced care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 70% compared to the national average of 88%.
  • The percentage of patients diagnosed with dementia whose care had been reviewed face to face in the preceding 12 months was 95% compared to the national average of 84%.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 3 February 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.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children and had attended training in how to recognise domestic abuse.
  • 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.