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Inspection summaries and ratings at previous address


Overall summary & rating

Good

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

Following a comprehensive inspection of Somerset Medical Centre on 21 July 2015, the practice was given an overall inadequate rating. Due to serious concerns about patient safety a decision was made to suspend the registration of the provider for a period of three months from 27 July 2015 to 27 October 2015. The provider appealed to a first-tier tribunal and a hearing was held on 01 October 2015. The appeal was dismissed by the tribunal upon agreement that we would re-inspect the practice on 14 October 2015 to assess if sufficient improvements had been made to allow the practice to re-open.

Following the inspection in October 2015 we found some improvements had been made however we still had concerns about the leadership of the practice and a decision was made to cancel the registration of the registered manager. The practice was placed in special measures and was found to be in breach of five regulations. Requirement notices were set for regulations 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008.

We then carried out an announced comprehensive inspection on 16 August 2016 to consider if all regulatory breaches in the previous

October 2015 inspections had been addressed and to consider whether sufficient improvements had been made to bring the practice out of special measures.

At this inspection we found the practice had a new leadership team in place who had worked with the Royal College of General Practitioners (RCGP) to make the necessary improvements to the service provided. We found significant improvements had been made. 

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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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 facilities and was equipped to treat patients and meet their needs although the premises were in need of a general upgrade.
  • There was a clear leadership structure and staff felt supported by management. The practice 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.

The areas where the provider should make improvement are:

  • Continue to improve the identification of disease and the coding of patients on the Quality and Framework Outcomes (QOF) registers.
  • Improve multidisciplinary team working to meet the needs of patients with complex conditions.
  • Record do not attempt cardiopulmonary resuscitation decisions on care plans where appropriate.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 September 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 29 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally below average compared to the national average. However, unpublished data from 2015/16 showed patient outcomes had improved.
  • 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 although multidisciplinary team working was an area in need of development.

Caring

Good

Updated 29 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice similar to others for most 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 29 September 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, staff had up skilled to provide out of hospital services such as spirometry and anticoagulation. However, the practice had been advised by the CCG not to provide these services whilst in special measures.
  • 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 facilities and was equipped to treat patients and meet their needs. However, the premises was in need of a general upgrade.
  • 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 29 September 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 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 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 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.
Checks on specific services

People with long term conditions

Good

Updated 29 September 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 74% which was 12% below the CCG average and 16% below the national average with a 13% exception rate. However, unpublished 2015/16 data provided by the practice showed their diabetes performance had improved to 93%.
  • 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 29 September 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 comparable to others 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 76%, which was comparable to the CCG average of 78% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 29 September 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 29 September 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 29 September 2016

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

  • 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 88% and the national average of 84%.
  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 29 September 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.