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Fountain Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fountain Medical Centre on 11 November 2015. Overall the practice is rated as good.

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

  • The practice had arrangements in place to deal with information about safety. Staff were aware of their responsibility to report incidents and concerns and knew how to do this. Information relating to safety was documented, monitored and reviewed.
  • Risks to patients and staff were assessed and well managed
  • Staff used best practice guidance to assess patients’ needs and plan their care.
  • The practice ensured all staff had received relevant role specific training and further training needs were identified for staff through appraisal
  • Patients told us that staff treated them with compassion, dignity and respect and involved them in decisions about their care
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was generally 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.
  • There were effective systems of governance in place and evidence of strategic planning for the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 February 2016

The practice is rated as good for providing safe services.

  • There were effective systems in place for reporting and recording significant events. Learning from significant events was shared widely within the practice and this was recorded in meetings minutes. Reviews of significant events were undertaken on a quarterly basis.

  • Where people were affected by safety incidents, the practice demonstrated an open and transparent approach to investigating these. Apologies were offered where appropriate.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. Designated GPs were responsible for safeguarding and they had regular meetings with attached health professionals to discuss patients at risk.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 11 February 2016

The practice is rated as good for providing effective services.

  • Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • Clinical audits demonstrated improvement. For example, an audit related to asthma in young children had demonstrated improvement management of these patients.

  • Data showed patient outcomes were at or above average for the locality. For example, the practice had the lowest rate of weighted referrals for elective treatment for the CCG area in addition to the lowest number of emergency admissions. 

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. We saw that a number of clinical staff had additional qualifications and special interests.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs. The practice held monthly multidisciplinary team meetings and worked closely with a range of health professionals.

Caring

Good

Updated 11 February 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for several of aspects of care. For example, 99% of patients had confidence and trust in the last GP they saw or spoke to.

  • Patients told us they were treated with care and concern by staff and that their privacy and dignity was respected. Feedback from comments cards aligned with these views.

  • The practice provided information for patients which was accessible and easy to understand.

  • We observed that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 11 February 2016

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. For example the practice had submitted a proposal to NHS England for improved premises.

  • The practice had good facilities and was well equipped to treat patients and meet their needs; however the practice did not have a hearing loop in their reception area. (Hearing loops help people who are deaf or hard of hearing pick up sounds more clearly)
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders including the patient participation group (PPG).
  • Patients said they generally found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.

Well-led

Good

Updated 11 February 2016

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

  • The practice had a clear vision to deliver high quality care. Information about the practice aims were shared with patients in their mission statement which was displayed in the practice. Staff were clear about the vision and their responsibilities in relation to this.

  • There was a clear leadership structure and staff felt supported by partners and management.

  • The practice had a wide range of policies and procedures to govern activity and held regular governance meetings.

  • The partners encouraged a culture of openness and honesty and staff felt supported to raise issues and concerns.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was well established and met regularly. The PPG worked closely with the practice to review issues including appointment access and parking.

  • There was a strong focus on continuous learning and improvement at all levels.
  • The practice was a teaching practice for medical students in addition to being a training practice.  
Checks on specific services

People with long term conditions

Good

Updated 11 February 2016

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

  • Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients identified as being at risk of admission to hospital were discussed at monthly multidisciplinary meetings.

  • Indicators to measure the impact of the management of diabetes were higher than local and national averages. For example, the percentage of patients on the practice register for diabetes with a record of a foot examination and risk classification in the last 12 months was 93.0%. This was marginally above the local and national averages.

  • Longer appointments and home visits were available for patients who required these.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people 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 11 February 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. The practice held regular meetings with attached professionals to discuss children identified as being at risk.

  • 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, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 78% which was comparable to the national average of 74.3%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments were always available on the day.

  • We saw good examples of joint working with midwives, health visitors and school nurses.

  • Two female GPs provided a service to fit coils and contraceptive implants. In addition a practice nurse was undertaking the family planning course. 

Older people

Good

Updated 11 February 2016

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.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice worked effectively with the multi-disciplinary team to identify patients at risk of admission to hospital and to ensure their needs were met. Multidisciplinary meetings were held at the practice on a monthly basis.

  • The percentage of people aged 65 or over who received a seasonal flu vaccination was 79.3% which was above the national average of 73.2%. Flu clinics were supported by the practice’s patient participation group (PPG).

Working age people (including those recently retired and students)

Good

Updated 11 February 2016

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. This included access to appointments including telephone consultations.

  • The practice was proactive in offering online services and all GP appointments were offered through the online booking system

  • Health promotion and screening was provided that reflected the needs for this age group.

  • Extended hours consultations were offered on Monday mornings and Saturday mornings to facilitate access for patients in this group.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 February 2016

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

  • Data showed that 77.4% of patients with a mental health condition had a comprehensive care plan documented in their records in the previous 12 months which was similar to the CCG average.

  • 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.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

  • Staff had a good understanding of how to support people with mental health needs and dementia. All staff and members of the patient participation group (PPG) had undergone training to become ‘Dementia Friends’ and the PPG had worked with the practice to ensure it was dementia friendly.

People whose circumstances may make them vulnerable

Good

Updated 11 February 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 those with a learning disability.

  • It offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice told 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. 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.