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Portobello Medical Centre Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 19 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Portobello Medical Centre on 12 May 2016. 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.
  • Clinical audits had been carried out, and

    one of these was a completed second cycle audit demonstrating quality improvement in patient outcomes.

  • 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 were able 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.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively 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 complete clinical audits through the full audit cycle  to further demonstrate where the improvements made are implemented and monitored to improve patient outcomes.
  • Review the system for the identification of carers to ensure all carers have been identified and provided with support.
  • Advertise in the reception area that translation services are available.
  • Update the practice’s policy on notifiable incidents in line with 2014 regulations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 August 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 19 August 2016

The practice is rated as good for providing effective services.

  • Clinical audits were used to drive quality improvement. One of the audits submitted as evidence for the inspection was a completed second cycle audit demonstrating such improvement.

  • Data from the Quality and Outcomes Framework (QOF) showed for the majority of indicators 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.
  • 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 19 August 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 19 August 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 the practice participated in CCG led audits such as gastroenterology referrals to ensure they were appropriate.
  • The majority of patients said they were able 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 19 August 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. However, the practice’s policy on notifiable incidents needed to be updated to reflect the new 2014 regulations.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had recently set up a patient participation group which was beginning to become 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 19 August 2016

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

  • The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • QOF performance for long term conditions management was generally above average. Performance for diabetes related indicators was below the national average but the practice was taking action to address this.
  • 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. This included close communication with district nurses and a primary care navigator.

Families, children and young people

Good

Updated 19 August 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 broadly comparable to CCG averages for all standard childhood immunisations.
  • The practice’s uptake for the cervical screening programme was 76%, which was comparable to the CCG average of 75% and 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. The practice also worked with the local ‘family nurse partnership’ to secure home visiting support for first time young mothers, aged 19 years or under.

Older people

Good

Updated 19 August 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 and same day access via the telephone for those with enhanced needs.
  • There was close liaison with the community matron, district nurses and primary care navigator for signposting patients and relatives to access services and for management of their conditions.
  • There was also close working with the local rapid response team, which included doctors and nurses to keep patients over 65 well, at home and out of hospital.
  • The practice worked to the Gold Standards Framework in supporting patients on its palliative care register and made use of the Co-ordinate my Care portal to register the wishes of patients and communicate with other services in supporting those patients.

Working age people (including those recently retired and students)

Good

Updated 19 August 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.
  • There was early morning opening for walk-in appointments, three days a week for working patients who could not attend during normal opening hours.
  • Same day access was available via the telephone or in face-to face consultations.
  • The practice provided an in-house phlebotomy service.
  • The practice provided a travel vaccination clinic.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 August 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 who had their care reviewed in a face to face meeting in the last 12 months, which is above the national average.
  • QOF performance for mental health related indicators was above average.
  • 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, including ‘Take time to talk’ for access a range of psychological therapies and support to patients who were anxious, depressed, stressed or worried.

  • 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 19 August 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 and 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. There was close liaison with a primary care navigator for signposting patients and relatives to access services and for support in the management of their conditions.

  • 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.