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Potteries Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

We previously inspected Potteries Medical Centre on 10 August 2016. Following this comprehensive inspection, the overall rating for the practice was Requires Improvement. A total of two breaches of legal requirements were found and two requirement notices were served. The practice provided us with an action plan detailing how they were going to make the required improvements in relation to:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Safe care and treatment.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Good Governance.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Potteries Medical Centre on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow up inspection at Potteries Medical Centre on 12 and 27 July 2017. Overall the practice is now rated as Good.

Our key findings were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • There was a formal system in place to log, review, discuss and act on external alerts, such as the Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver care and treatment.
  • Patients said they were treated with kindness, 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. Improvements were made to the quality of care and access to services as a result of complaints and concerns.
  • Data from the national GP patient survey published July 2017 showed patient satisfaction continued to be above local Clinical Commissioning Group (CCG) and national averages for all but two areas measured.
  • There was a clear leadership structure in place and staff felt supported by the management team. The practice responded positively to feedback from staff and patients.
  • The practice had improved procedures for the storage of emergency medicines and regular checks were undertaken to ensure medicines were fit for use.
  • Effective systems were now in place for identifying and assessing the risks to the health and safety of patients and staff.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • Patients found it easy to make an appointment, with urgent appointments available the same day.
  • Governance arrangements had improved to include the formalisation of clinical and reception staff meetings.
  • The practice was limited by the size of their facilities, however it was equipped to treat patients and meet their needs.
  • Clinical audits demonstrated quality improvement in patient outcomes.

The areas where the provider should make improvements are:

  • Consider obtaining written consent for the insertion of intrauterine (coil) contraceptive devices.
  • Review the security of treatment and consultation rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 August 2017

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.

  • The practice had clearly defined and embedded safeguarding procedures in place. Staff demonstrated that they understood their responsibilities and had received training on safeguarding children and vulnerable adults relevant to their role.

  • Arrangements for identifying, recording and managing risks and implementing mitigating actions had improved to ensure that patients and staff were protected from the risk of harm at all times.

  • The practice system for prescribing high risk medicines on a shared care basis had improved ensuring patients had received the recommended monitoring before prescriptions were issued.

  • There was a formal system in place to log, review, discuss and act on external alerts, such as the Medicines and Healthcare products Regulatory Agency (MHRA) alerts.

  • The practice had reviewed and improved their systems to help manage unplanned emergency events. An Automated External Defibrillator (AED) had been obtained in addition to specific medicine for use in the event of cervical shock when performing coil fittings.

Effective

Good

Updated 18 August 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 local and national averages for most clinical indicators.

  • Staff were aware of and worked in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement in patient outcomes.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of completed appraisals for staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 18 August 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in July 2017 showed patients rated the practice higher than others for most aspects of care.

  • CQC comment cards and surveys we reviewed and discussions held with patients showed 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.

  • Staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice had 132 patients identified as carers (3% of the practice list) and offered free flu vaccines.

Responsive

Good

Updated 18 August 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.

  • Home visits were triaged by a GP to assess whether a home visit was clinically necessary and the urgency of the need for medical attention.
  • Routine appointments were available with a clinician within 48 hours. Same day appointments were available for children and those patients with medical problems that required urgent consultation.
  • Patients we spoke with said they found it easy to make an appointment, with urgent appointments available the same day.

  • The practice was limited by the size of their facilities, however it was equipped to treat patients and meet their needs.
  • There was a designated person responsible for handling complaints. Information about how to complain was available and evidence reviewed showed the practice responded to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 18 August 2017

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

  • The practice had a 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. The partners encouraged a culture of openness and honesty and staff felt supported by the management team.

  • The practice had policies and procedures to govern activity. Regular reception staff and clinical staff meetings were now formalised and meetings held were recorded.

  • Effective systems were now in place for managing risk to ensure that patients and staff were protected from the risk of harm.

  • The provider was aware of the requirements of the duty of candour.

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

  • 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.

Checks on specific services

People with long term conditions

Good

Updated 18 August 2017

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

  • There was a system to recall patients for ongoing monitoring and a structured six monthly or annual review to check their health and medicines needs were being met.

  • The practice provided care plans and priority access for patients on the admissions avoidance register.

  • Performance for diabetes related indicators was comparable to the CCG and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 79% compared with the CCG and the national average of 78%. The practice exception reporting rate of 2% was lower than the CCG average of 9% and the national average of 12.5%.

  • For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care and held.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 18 August 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 children who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.

  • Immunisation rates for the vaccinations given were above standard for childhood vaccinations for children aged two and higher than the Clinical Commissioning Group (CCG) for children aged five. Dedicated baby clinics were held every Thursday morning.

  • Same day appointments were available for children with urgent medical need.

  • Education booklets regarding childhood illnesses were available for patients.

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

  • Family planning services was available in addition to lifestyle advice on healthy living.

Older people

Good

Updated 18 August 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 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 provided care plans and priority access for patients on the admissions avoidance register.

  • The practice held a register of housebound patients.

  • The practice followed up on older patients on the hospital admission avoidance register when discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Patients aged 75 years or over had a named GP.

Working age people (including those recently retired and students)

Good

Updated 18 August 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 these were accessible, flexible and offered continuity of care, for example, clinics were provided daily until 6.30pm and until 8pm on a Tuesday evening.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

  • Lifestyle advice regarding healthy eating and smoking cessation were available.

  • New patient health checks in addition to NHS Health checks for patients aged 40 to 74 years were available.

  • The practice allowed the temporary registration of students whilst home on holiday leave.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 August 2017

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

  • Performance for mental health related indicators was comparable to the local CCG and national averages. For example, the percentage of patients with an agreed care plan documented in the preceding 12 months was 93% compared to the CCG average of 90% and national average of 89%. The practice clinical exception rate of 3% which was lower than the local CCG average of 11.5% and the national average of 12.7%.

  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the last 12 months was 79%, which was slightly lower than the CCG and national averages of 84%. However, the practice clinical exception rate of 0% was lower than the CCG and the national averages of 7%.

  • 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 to signpost patients experiencing poor mental health and were able to refer patients or patients could self-refer to a consortium made up of specialist mental healthcare providers.

People whose circumstances may make them vulnerable

Good

Updated 18 August 2017

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

  • The practice offered longer appointments for patients with a learning disability and for patients with complex needs.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • The practice had 47 patients recorded with a learning disability. Twenty one of these patients had received an annual health assessment since 1 July 2016. There were plans for more reviews to be scheduled shortly.

  • The practice had information available for patients about how to access various support groups and voluntary organisations.

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