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Moordown Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moordown Medical Centre on 23 February 2016. 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 an effective system in place for reporting and recording significant events.

  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Data showed the practice was performing highly when compared to neighbouring practices in the Clinical Commissioning Group. For example, the

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available and easy to understand.

  • 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.

  • 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 and complied with the requirements of the Duty of Candour.

    We saw several areas of outstanding practice:

  • The practice was involved in a collaborative project with two other local practices. The project was funded by an over 75’s project scheme by Dorset clinical commissioning group, known as the Anticipatory Care Team. The project was aimed at reducing emergency hospital admissions by offering routine and urgent care to frail older patients who could not easily access practice facilities. The team consisted of a nurse practitioner and nurse, with an administrator. The nurse practitioner undertook acute visits, allowing prompt assessment and treatment (usually earlier in the day than a GP could visit). We saw data that showed a 3.4% decrease in patients admitted to hospital in the period from January to December 2015 compared to the same period the year before. This related in real terms to 23 less patients being admitted to hospital.

  • The practice had a quality improvement plan in place. Each GP chose a clinical area, for example, diabetes. They then undertook some research into the latest good practice including current NICE guidelines, if required they undertook some further training, they then discussed their findings with the other clinicians within the practice and agreed actions to improve patient care. For example, a new updated protocol was introduced for patients taking oral medicines for diabetes control to ensure more specific and targeted prescribing. This protocol was also embedded into the clinical system.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients needs. For example, the practice communicated and liaised with peri-natal mental health services, such as the Sunshine Team. These patients were discussed at multi-disciplinary team meetings to ensure their pre-birth care and treatment took account of their mental health needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 March 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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 in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

  • Recruitment procedures and checks were completed as required to ensure that staff were suitable and competent.

  • There were arrangements for the efficient management of medicines.

  • The practice was clean, tidy and hygienic. We found that arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.

Effective

Outstanding

Updated 31 March 2016

The practice is rated as outstanding 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. Evidence showed guidelines were positively influencing and improving practice and outcomes for patients.

  • Data showed the practice was performing highly when compared to neighbouring practices in the CCG. For example, the

  • Moordown Medical Centre was involved in a collaborative project with two other local practices, funded by an over 75s project scheme by Dorset clinical commissioning group known as the Anticipatory Care Team. The project was aimed at reducing emergency hospital admissions by offering routine and urgent care to frail older patients who could not easily access practice facilities. The team consisted of a nurse practitioner and nurse, with an administrator. The nurse practitioner undertook acute visits, allowing prompt assessment and treatment (usually earlier in the day than a GP could visit.We saw data that showed a 3.4% decrease in patients admitted to hospital in the period from January to December 2015 compared to the same period the year before. This related in real terms to 23 less patients being admitted to hospital.

  • The practice used innovative and proactive methods to improve patient outcomes and it linked with other local providers to share best practice. The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care.

  • Staff, teams and services were committed to working collaboratively.

Patients who had complex needs were supported to receive coordinated care and there were innovative and efficient ways to deliver more joined-up care to patients who used the services.

Caring

Good

Updated 31 March 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey July 2015 showed patients rated the practice higher than others for several aspects of care.

  • 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 and information confidentiality.

Responsive

Good

Updated 31 March 2016

The practice is rated as good for providing responsive services.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group

    . For example, by ensuring better information was made available to patients in the waiting area.

  • Patients 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 easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 31 March 2016

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.

  • 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.

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

  • 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

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was well established and were keen to support improvement with the support of the practice manager.

Checks on specific services

People with long term conditions

Good

Updated 31 March 2016

The practice is rated as good for the care of patients 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine 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.

  • The practice had GPs with special interests including dermatology and minor operations. Patients were referred internally to the specific GP and had treatment within the practice, saving them from having to attend an outpatient’s appointment at the general hospital.

  • Special messages were attached to the computerised patient records that Out of Hours services could access, to ensure consistent care. If a patient was admitted to hospital, the practice sent a written summary to the hospital with details of both the current problem and of past medical history. Information sent included current medicines and allergies, to help enable consistent and safe of care.

  • The practice offered extended hour’s appointments to allow access to working age patients with chronic diseases.

Patients with long term conditions were offered a referral to a health coach to support their self-management of their condition.

Families, children and young people

Good

Updated 31 March 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 had well organised baby and child immunisation programmes and there were safeguards in place to follow up any appointments that were not attended. The practice offered same day appointments for children. There was a quiet private room available for women to use to breast freed if required

  • 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.

  • Women had good access to a full range of contraception services and sexual health screening including cervical screening. A robust recall and follow up was in place for cervical and breast screening. For example, the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to31/03/2015) was 94.87% compared to the national average of 81.83%

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw good examples of joint working with midwives, health visitors and school nurses. There was a community health visitor team based at the practice resulting in robust and effective relationships to access support and advice for parents and young families. The health visitor team attended the practice monthly meetings to discuss vulnerable children and families of concern.

Older people

Good

Updated 31 March 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

  • The practice was involved in a collaborative project with two other local practices. The project was funded by an over 75’s project scheme by Dorset clinical commissioning group, known as the Anticipatory Care Team. The project was aimed at reducing emergency hospital admissions by offering routine and urgent care to frail older patients who could not easily access practice facilities. The team consisted of a nurse practitioner and nurse, with an administrator. The nurse practitioner undertook acute visits, allowing prompt assessment and treatment (usually earlier in the day than a GP could visit). We saw data that showed a 3.4% decrease in patients admitted to hospital in the period from January to December 2015 compared to the same period the year before. This related in real terms to 23 less patients being admitted to hospital.

  • Integrated health and social care meetings incorporating mental health and the voluntary sector occurred monthly to discuss issues arising from the wider primary care team. Meeting involved a range of professionals including the district nurses, community matrons, practice nurses, GPs, social services and the anticipatory nursing team.

  • Patients who were housebound received a proactive comprehensive geriatric assessment by the anticipatory care nursing team to identify potential issues focusing on hearing, sight, continence, support networks, medicines management and mobility/balance.

Working age people (including those recently retired and students)

Good

Updated 31 March 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.

  • Extended hours were offered twice a week from7:30am until 8am and from 630pm until 8pm once a month. These appointments were bookable in advance to allowed easier planning around work.

  • Practice services included online appointments and online repeat prescriptions, telephone consultations and comprehensive information on the practice website to allow working patients to easily access the service.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 March 2016

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

  • 95.16% of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, which is better to the national average of 84.01%.

    The practice 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 patients with mental health needs and dementia. All staff had received training in the Mental Capacity Act and consent.

  • The Practice has a lead GP for mental health patients. Patients with depression were actively monitored and regularly reviewed. The practice had good relationships and communication with community mental health teams, who also attended multi-disciplinary meetings at the practice for discussion of patient care. The practice liaised with the voluntary sector, who also attended those meetings, for additional support.

  • Medicine reviews were conducted to ensure compliance and appropriate prescribing, with monitoring blood tests or other tests as required. A mental health template which was incorporated on the clinical system was used by GPs when prescribing, this was updated annually or sooner to incorporate the latest guidance on prescription monitoring.

  • The Practice communicated and liaised with peri-natal mental health services, such as the Sunshine Team. These patients were discussed at multi-disciplinary team meetings to ensure their pre-birth care and treatment took account of their mental health needs.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice used specialist templates for assessment and monitoring of patients together with dementia care plans which were agreed with the patient and/or carers. The practice had a proactive approach to review of these patients, with referrals to other outside agencies that could offer support and care to the patient and their families.

People whose circumstances may make them vulnerable

Good

Updated 31 March 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, and those with a learning disability. There was a person centred approach, which ensured the more vulnerable patients received a good level of care. . The practice also offered longer appointments for patients with a learning disability.

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

  • The practice identified all housebound patients including a small number that lived in care homes. Proactive personalised anticipatory care plans were in place for each of these patients. These care plans reflected patient identified goals and included information such as a falls risk assessment, medicines management, social and mental health issues and end of life choices. The care plans were shared with other professional and the out of hour’s service to ensure good continuity of care.

  • Proactive reviews of housebound patients were undertaken by a shared federative nursing team who undertook comprehensive assessments to identify issues which were dealt with or signposted to the appropriate community team.

  • A dedicated member of the administration staff was the carers lead. This person supported carers by ensuring they received a carers information pack which supported them to access further community support including benefits advice. The practice had good information in the waiting room to support carers.