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Inspection Summary


Overall summary & rating

Good

Updated 22 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North End Medical Centre on 5 April 2016. Overall the practice is rated as Good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • Feedback from patients about their care was consistently positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

  • 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.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw some areas of outstanding practice including:

  • The practice also took part in a programme of Community Health workshops on diabetes, in partnership with a local voluntary agency. We saw these workshops included cooking demonstrations, sample recipes, medical and practical advice and a free diabetic-friendly lunch was also served. The workshops were delivered on a monthly basis and attendance ranged from 50 – 100 at each workshop. Performance for diabetes related indicators was 100% which was 17% above the CCG and 11% above the national average.

The areas where the provider should make improvement are:

  • The practice should review, with an aim to reducing their level of exception reporting in relation to Quality Outcome Framework (QOF).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 July 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 things went wrong patients received reasonable support, truthful information, and a 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.

Effective

Good

Updated 22 July 2016

The practice is rated good for providing effective services.

  • Our findings at inspection showed that 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.
  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients. The practice had developed clinical protocols so that the links to NICE and other bodies were embedded in clinical practice.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • The practice met with other local providers to share best practice.
  • 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 22 July 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for some 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 22 July 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, local referral pathways for diabetes patients.

  • 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.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

Well-led

Outstanding

Updated 22 July 2016

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

  • The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. The Contracts and performance manager was responsible for implementing and monitoring appropriate reporting systems to measure their QOF performance. The QOF data for this practice showed it was performing above national standards.

  • There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. All staff were involved in discussions about how to run and develop the practice, and the partners encouraged all members of staff to identify opportunities to improve the service delivered by the practice.

  • There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment. The practice took part in local pilot schemes to improve outcomes for patients in the area. For example, the practice worked in partnership with a local charity and had appointed a social prescriber to provide non-medical support to patients.

  • The practice initiated and hosted weekly lunch time teaching events delivered by consultants which was open to other local practices and all the clinical staff at the practice including the nurses.

  • The practice had received an award for their performance in providing NHS health checks to their eligible population. They had 29% achievement against a CCG area average of 20%.
  • The practice gathered feedback from patients using new technology, and it had a very engaged patient participation group. They PPG had organised and helped facilitate a ‘food bank’ for vulnerable patients. 
Checks on specific services

People with long term conditions

Outstanding

Updated 22 July 2016

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

  • The practice had clinical leads for a variety of long term conditions including diabetes and chronic obstructive pulmonary disease (COPD). We saw all clinical members had completed further training in their areas of responsibility and acted as a source of information for other staff. For example, the diabetes lead had completed the ‘merit course’ (Meeting Educational Requirements, Improving Treatment) which is a flexible modular education programme that helps healthcare professionals to update and deepen their knowledge of diabetes treatment and care so they can better help their patients.

  • The practice provided weekly dedicated diabetic clinics run by two GPs and a practice nurse who had also completed specialist training. They were able to initiate insulin and other injectable therapies such as GLP-1 (long acting glucagon) which meant patients did not need to go to community clinics or to secondary care.

  • The practice also took part in a programme of Community Health workshops on diabetes, in partnership with a local voluntary agency. We saw these workshops included cooking demonstrations, sample recipes, medical and practical advice and a free diabetic-friendly lunch was also served. The workshops were delivered on a monthly basis and attendance ranged from 50 – 100 at each workshop.

  • The practice held registers for patients in receipt of palliative care, had complex needs or had long term conditions. GPs attended regular internal as well as multidisciplinary meetings with district nurses, social workers and palliative care nurses to discuss patients and their family’s care and support needs.

  • The practice provided dedicated COPD and asthma clinics run by their trained nurse who performed spirometry and peak flow tests. These clinics were overseen by dedicated GPs (one each for COPD/asthma) and their advanced nurse practitioner. Patients were given self-management plans including ‘rescue pack’ antibiotics and oral steroids.

  • Services such as spirometry, phlebotomy, ambulatory blood pressure monitoring (ABPM) and anticoagulation management service were carried out at the practice.

Families, children and young people

Good

Updated 22 July 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, they had a named administrative staff member who monitored paediatric non-attenders to hospital out-patient and community services. 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 GPs demonstrated an understanding of Gillick competency and told us they promoted sexual health screening.

  • The practice’s uptake for the cervical screening programme was 81%, which was comparable to the national average of 82%.
  • The practice triaged all requests for appointments on the day for children when their parent requested the child be seen for urgent medical matters, thus were able to offer appointments at mutually convenient times, for example after school, when appropriate.

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

Older people

Good

Updated 22 July 2016

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Patients over 75 years had a named GP to co-ordinate their care. They had identified that 7% of their older patients were at risk hospitalisation and all had care plans in place. Double appointments were available for these patients when required.

  • Patients were referred to the older person’s rapid access clinic and the practice used the virtual ward to prevent unnecessary hospital admissions. Patients in the group were also referred to their pilot social prescribing service for non-medical care needs.

  • The practice utilised other support services, such as referring patients to a befriending service run by a local charity, the local Red Cross Services and Healthier Homes. Healthier Homes is a Public Health funded project aimed at reducing GP appointments and Hospital Admissions. It focuses on the health effects of fuel poverty and hazards in the home.

Working age people (including those recently retired and students)

Good

Updated 22 July 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. There was GP telephone triage for all requests for same day appointments, which enabled telephone and email consultations where appropriate.

  • The practice offered working age patients access to extended appointments six times a week which included weekend appointments.

  • 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.

  • Pathology results were also sent by SMS texts when requested.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 July 2016

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

  • There was a GP lead for dementia and they carried out advanced care planning for patients with dementia and had achieved 93% of the latest QOF points, which was above the CCG averages.

  • 80% of the practice staff had received Dementia Friends training.

  • The practice had double the national prevalence of patients with severe enduring mental health problems and many more with common complex mental illness. One hundred and forty eight had a comprehensive care plan and these patients were invited to attend annual physical health checks and 132 had been reviewed in the last 12 months

  • They had mental health lead GP and there was a primary care mental health worker (PCMH) based at the practice one day a week whose role included supporting patients with mental illness transfer from secondary care back to primary care. There were monthly reviews of all patients being seen by the PCMH worker with the lead GP. Patients were also referred to other services such as Back-on-Track and IAPT (Improving Access to psychological therapies) for CBT and counselling.

  • 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.

  • The practice also provided support to three local mental health hostels. They had good working relationships key workers who could request appointments at suitable time for their clients.

People whose circumstances may make them vulnerable

Good

Updated 22 July 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, travellers and those with a learning disability. Pop up alerts were placed on all computer notes to alert all members of staff of vulnerable patients.

  • Learning Disability patients were given care plans that met their needs. Patients with learning disabilities were invited annually for a specific review with their named GP, often on a Saturday when the practice was quieter. We saw 14 out of 17 reviews had been carried out in the last 12 months.

  • 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 had a relatively large amount of substance misuse patients and there were Drug and Alcohol workers attached to the practice three days per week, which allowed effective monitoring of these vulnerable patients. They worked in partnership with the lead GP who had the RCGP Certificate parts 1 and 2 in the management of drug misuse, providing three clinics a week. There were 34 patients on substitute medication that were being supported by the practice. These patients were reviewed on a regular rolling monthly cycle.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. We saw they would refer patients to other services such as Cognitive Behavioural Therapy (CBT).

  • 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.