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Inspection Summary


Overall summary & rating

Good

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clifton Medical Centre on 17 February 2016. The overall rating for the practice was good but with requires improvement for safety. The full comprehensive report for the 17 February 2016 inspection can be found by selecting the ‘all reports’ link for Clifton Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Improvements had been made since our last inspection on 17 February 2016. Our key findings were as follows:

  • The practice had obtained all the necessary staff recruitment checks to ensure employees were of good character prior to employment.

  • Storage arrangements had been improved to ensure all flooring areas were free from clutter and could be cleaned appropriately.  

PProfessor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 March 2017

Improvements had been made since our last inspection on 17 February 2016 and the practice is now rated as good for providing safe services. Our key findings were as follows:

  • The practice had obtained all the necessary staff recruitment checks to ensure the person was of good character prior to employment.

  • Storage arrangements had been improved to ensure all flooring areas were free from clutter and could be cleaned appropriately.

Effective

Outstanding

Updated 11 April 2016

The practice is rated as outstanding for providing effective services.

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

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement. We also saw evidence to confirm that the findings were positively influencing and improving practice and outcomes for patients.

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

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice.

We saw some areas of outstanding practice including:

  • Clifton Medical Centre formed and is the centre for a unique and specialist service for the management of weight problems. This service was open to all patients in the Rotherham CCG. There were positive documented outcomes for patients and for financial savings for the NHS. This service had been replicated at several sites around the UK.

  • The practice had a dedicated long term conditions (LTC) team led by a GP who had dedicated time for this area of practice. The team also included two nurses with specific training in this area. They had identified the top 5% of patients, just over 600 patients, at the most risk of unplanned hospital admissions using a recognised risk tool. These patients had detailed assessments and care plans which included carer’s assessments, and care needs were monitored and reviewed regularly. Patients told us they were well supported by this team and were called regularly for reviews.

  • The practice had developed a safety programme for housebound patients with atrial fibrillation (AF). The practice had made sure that all patients with AF had been assessed for the risk of a stroke using a risk tool, had received appropriate medication and had ensured this decision was regularly reviewed and monitored. They had also ensured all patients with AF who were prescribed warfarin had alert cards issued and families and carers knew what to do in an emergency. The practice had developed a form for recording necessary information when tests used to monitor the effects of warfarin were performed in patients own home using Near Patient Testing systems. This form and its use across Rotherham had been adopted by Rotherham NHS Trust.

Caring

Good

Updated 11 April 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. Feedback from patients about their care and treatment was consistently and strongly positive.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • Information for patients about the services available was easy to understand and accessible.

We saw areas of outstanding practice including:

  • The practice ensured patients had relevant information and were able to be involved in their care. Information leaflets relating to complaints, health checks and smear tests were available in easy to read formats and were available in the practice and on the website. Information about hand hygiene had been translated into a number of languages and displayed close to patient hand hygiene facilities. They had also ensured all patients with AF who were prescribed warfarin had alert cards issued and families and carers knew what to do in an emergency. The practice had developed a form for recording necessary information when tests used to monitor the effects of warfarin were performed in patients own home using Near Patient Testing systems. This form and its use across Rotherham had been adopted by Rotherham NHS Trust.

Responsive

Good

Updated 11 April 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 and other stakeholders.

Well-led

Good

Updated 11 April 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. However, some recruitment procedures required improvement.

  • 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. 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 11 April 2016

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

  • The practice had a dedicated long term conditions (LTC) team led by a GP who had dedicated time for this area of practice. The team also included a nurse with specific training in this area.

  • They had identified the top 5% of patients, just over 600 patients, at the most risk of unplanned hospital admissions using a recognised risk tool. These patients had detailed assessments and care plans which included carer’s assessments. Care needs were monitored and reviewed regularly by the multidisciplinary team. The practice had good systems in place to monitor patients with long term conditions, for example, the hospital discharge letters were collated with the LTC register. A search was conducted twice a week to check if any patients on the LTC register had been discharged from hospital.

  • All these patients had a named GP.

  • Performance for diabetes related indicators was 83%, which was the same as the CCG average but below the national average of 90%.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 11 April 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.

  • In the last 12 months 73% of patients diagnosed with asthma had received a review of their care, which was the same as the CCG average and 2% below the national average.

  • Patients told us that children and young people were treated in an age appropriate way and were recognised as individuals, and we saw evidence on the day of the inspection to confirm this.

  • The practice’s uptake for the cervical screening programme was 78%, which was comparable to the CCG average of 82% and the national average of 81%.

  • 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, health visitors and school nurses.

  • The practice had ensured young people had access to information about services which was relevant to their needs.

Older people

Good

Updated 11 April 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.

Working age people (including those recently retired and students)

Good

Updated 11 April 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 reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 April 2016

  • In the last 12 months 94% of patients diagnosed with dementia had received a face to face review of their care, which was 9% above the CCG and national average.

  • Performance for mental health related indicators was 100%, which was better than the CCG average of 91% and national average of 93%.

  • The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those living with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • Patients experiencing poor mental health had been advised 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 and had received training in this area.

People whose circumstances may make them vulnerable

Outstanding

Updated 24 March 2017

The practice is now rated as outstanding for the care of people whose circumstances may make them vulnerable. The provider had resolved the concerns for safety identified at our inspection on 17 February 2016 which applied to everyone using this practice, including this population group. This population group rating has been updated to reflect this. At the last inspection on the 17 February 2016 the practice was rated as outstanding for providing effective and caring services for people whose circumstances may make them vulnerable.