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Sands End Health Clinic Good

Inspection Summary


Overall summary & rating

Good

Updated 19 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sands End Health Clinic on 20 April 2016. The overall rating for the practice was good but required improvement for providing safe services. This was specifically in relation to some aspects of medicines management and fire safety precautions. The full comprehensive report on the 20 April 2016 inspection can be found by selecting the ‘all reports’ link for Sands End Health Clinic on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 19 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 20 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated good for providing safe services and the overall rating remains as good.

Our key findings were as follows:

  • Improvements had been made in the management and storage of medicines which now included an effective fridge temperature monitoring process and, a system to monitor that all medicines kept at the practice were in date.
  • Effective fire safety arrangements were now in place including fire extinguishers that were fit for purpose.

We also reviewed the actions taken since the last inspection to the areas where we identified the practice should make improvement and saw that they had been addressed.

Our findings were as follows;

  • Staff who undertook chaperone duties had undertaken additional training to expand their competency skills to effectively perform the role.
  • Improvements had been made to the practice’s cervical screening uptake rates. Data for 2015/16 showed that the percentage of women aged 25 to 64 years of age who had a cervical screening test performed in the preceding 5 years was comparable with the Clinical Commissioning Group (CCG) and national averages.
  • The practice had increased the number of patients identified as carers and currently had a carer’s register of 167 patients (2% of the practice list size).
  • Information about interpreting services was now made available to patients.
  • Arrangements were in place for the purchase of a new hearing loop to assist patients with a hearing impairment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 June 2017

The practice is rated as good for providing safe services.

  • Arrangements for managing medicines, including emergency drugs and vaccinations, in the practice kept patients safe.
  • Risks to patients in relation to fire safety were assessed and well managed.

Effective

Good

Updated 4 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • 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.

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

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

Caring

Good

Updated 4 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey 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 4 November 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.

  • 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.

Well-led

Good

Updated 4 November 2016

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

  • The practice had a clear vision to provide the best possible quality service for patients within a confidential and safe environment. Staff were clear about the vision and their responsibilities in relation to it.

  • 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 meetings.

  • There was an overarching governance framework which supported the delivery of 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 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. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 4 November 2016

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.

  • Performance for diabetes related indicators was better than the national averages. Performance for the percentage of patients on the diabetes register with a record of a foot examination was 91% in comparison to the national average of 88%; the percentage of patients with diabetes, on the register, who had received an influenza immunisation, was 98% in comparison to the national average of 94%.

  • 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 4 November 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. 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.

  • The practice’s uptake for the cervical screening programme was 68%, which was below the national average of 82%.

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

  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 4 November 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.

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

  • The practice worked with the ‘Older Person Rapid Access Clinic’ (OPRAC) which offers emergency department-style access to tests and diagnostics and providestreatment in a setting adapted for treating frail older patients; to meet the needs of older patients with specific medical problems.

Working age people (including those recently retired and students)

Good

Updated 4 November 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.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 November 2016

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 better than the national averages. 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had received a comprehensive, agreed care plan which was above the national average of 84%.

  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face consultation in the last 12 months was 87% which was above the national average of 84%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice 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.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 4 November 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.

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

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • 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. 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.