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Inspection Summary


Overall summary & rating

Good

Updated 21 September 2018

We carried out an announced comprehensive inspection at Ripley Medical Centre on 10 May 2016. The overall rating for the practice was ‘Good’, but the practice was rated ‘Requires Improvement’ for providing safe services. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Ripley Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based follow up review carried out on 28 August 2018 to review actions taken by the practice since our previous inspection in May 2016. This report covers our findings in relation to actions taken by the practice since our last inspection in the area of ‘Safe’ and other areas for improvement which we had identified at the May 2016 inspection.

Overall the practice remains rated as ‘Good’. The practice is now also rated ‘Good’ for providing safe services.

Our key findings were as follows:

  • The practice had reviewed their chaperone protocol and consent policy since our last inspection. In addition, all staff who acted as chaperones had been trained and had had their competency to carry out the role assessed to ensure that they were competent to act as chaperones when required to do so.
  • The practice had introduced room-specific cleaning schedules and carried out audits to monitor and ensure that cleaning had been undertaken to the required specification.
  • The practice had trained all relevant staff in the area of basic life support to ensure staff were competent in this area.
  • The practice had reviewed their systems for recalling patients with chronic diseases. The practice had amended their recalls protocol to include telephone calls and text reminders as methods for recalling patients, in addition to contact by letter, to ensure that appropriate efforts were made to recall patients with chronic diseases for review.
  • The practice had made a number of changes to improve patient access to appointments. These included improvements to the appointments system and providing extended hours’ appointments on Tuesdays and Thursdays.
  • The practice had provided staff with more time for training to ensure that staff completed all mandatory training as identified by the provider.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 September 2018

Effective

Good

Updated 26 July 2016

  • The practice adhered to local and NICE guidance, for example when treating patients for the management of long-term conditions.
  • Data showed patient outcomes were generally above average for the locality. The practice had achieved an overall figure of 99.5% for the Quality and Outcomes Framework 2014-15. This was 2.5% above the CCG average and 4.8% above the national average. The exception reporting rate at 9% was broadly in line with local and national averages.
  • Clinical audits demonstrated quality improvement, and we saw examples of audits that had produced positive outcomes in patient care and treatment. We saw one that had been conducted over two cycles
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. GPs had specific areas of interest and acted as a resource for their colleagues.

  • All staff had received a general induction, and clinical staff had received a robust role specific induction. All staff had received a performance review in the last 12 months which included an analysis of their training needs but not all staff had received training the provider considered to be mandatory.
  • Staff had received training appropriate to their role, however, there were a number of clinical and non clinical staff who had not completed statutory and mandatory training updates.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs, in order to deliver care more effectively. This was supported by monthly meetings attended by a wide range of health and care professional staff.
  • Staffing needs were kept under review to ensure the needs of patients could be effectively fulfilled.

Caring

Good

Updated 26 July 2016

  • We observed a strong and visible patient-centred culture. Staff were motivated to offer personalised care that promoted people’s dignity. Staff treated patients with kindness and respect, and maintained confidentiality throughout our inspection.
  • Patients we spoke with during the inspection, and feedback received on our comments cards, indicated they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment.
  • Data showed that patients generally rated the practice in line with local and national averages in respect of care. For example, 87% said the GP was good at treating them with care and concern compared to the CCG average of 86%, and the national average of 85%.
  • The practice adopted a flexible approach in dealing with vulnerable patients to ensure their individual needs were accounted for. This included seeing patients opportunistically at short notice in recognition that some patients found it difficult to engage with health care.
  • The practice manager had been assigned as the practice carer’s lead. The practice were proactive in identifying patients who were also carers and provided a range of support for them, including access to a wellbeing worker and a 60 minute carers’ clinic appointment.
  • Feedback from community based health care staff and care home staff was consistently positive with regards to the high levels of care provided by the practice team.
  • The practice provided personalised care to those patients at end-of-life. Practice data showed that 47% of patients had died within their preferred place as a consequence of the planning and support offered by the practice working in conjunction with the wider health and social care teams. Those who did not die in their preferred place were supported to die in the most appropriate place according to individual need.

Responsive

Good

Updated 26 July 2016

  • The practice operated a morning ‘sit and wait’ clinic offering open access to all patients. All patients arriving before 10.30am would be seen by a GP. However, patients had to wait for up to two hours to see a GP under this system. Patients we spoke with had mixed views about this system.
  • Bookable GP appointments were provided each afternoon. However, these could only be booked two weeks ahead, with one day’s appointments being released each day.
  • Comment cards and patients we spoke with during the inspection were generally positive about their experience in obtaining a routine appointment. This was reinforced by the national GP survey in January 2016 which found 75% patients described their experience of making an appointment as good. This was in comparison to a CCG average of 73% and a national average of 73%.
  • The practice hosted a range of services on site which made it easier for their patients to access. This included a weekly clinic provided by a consultant psychiatrist; and a weekly Citizens Advice Bureau session to assist with benefits advice
  • The practice implemented improvements and made changes to the way it delivered services as a consequence of feedback from patients.
  • The premises provided modern and clean facilities and were well-equipped to treat patients and meet their needs. The practice accommodated the needs of patients with disabilities, including access via automatic doors and the availability of a hearing loop.
  • The practice provided care for 27 residents in a local care home. We spoke with staff in the home who informed us that the practice was very responsive to their patients’ needs. Urgent visits were done on the day when required and weekly ‘ward round’ visits ensured patients were kept under regular review.
  • Information about how to complain was available on speaking to a receptionist, however there was no written information or poster displayed in the waiting area. The practice responded quickly when issues were raised and learning from complaints was shared with staff to improve the quality of service.
  • If patients at reception wished to talk confidentially, or became distressed, they were offered a private room next to the waiting area.

Well-led

Good

Updated 26 July 2016

  • The GPs had a vision to deliver high quality care and promote good outcomes for patients. Practice values had been recently revised with practice staff and underpinned the practice’s work and staff were clear about their responsibilities in relation to this.
  • There was an overarching governance framework which supported the delivery of the values and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider, Derbyshire Community Healthcare Services NHS Trust (DCHS) encouraged the practice to maintain its own identity as it was now integrated into a much larger organisation. DCHS also actively encouraged ongoing collaboration with other local practices and the CCG.
  • The recent change in leadership structure provided benefits such as Human Resources support for staff recruitment processes; and access to DCHS training programmes.
  • Staff felt supported by the practice management team and generally looked forward to changes and improvements that working within a larger team might provide. The practice held regular staff meetings.
  • The GPs reviewed comparative data provided by their CCG and ensured actions were implemented to address any areas of outlying performance.
  • The practice had developed a range of policies and procedures to govern activity although these were now in the process of review to ensure they were in alignment with the new provider.
  • The practice sought feedback from patients and staff, which it acted on to improve service delivery.
  • The patient participation group (PPG) helped inform practice developments, for example, by providing communication for patients regarding changes
Checks on specific services

People with long term conditions

Good

Updated 26 July 2016

  • QOF achievements for clinical indicators at 99.5% were higher than CCG and national averages (97% and 94.7% respectively)
  • The practice undertook annual reviews for patients on their long-term conditions registers. The review occurred in the patient’s birthday month and included a review of each patient’s prescribed medicines. An additional review was usually conducted after any hospital admission.
  • NHS health checks were provided to assist in the early identification of chronic disease to enable early intervention and treatment where this was required.
  • There were nurse-led clinics available to support patients with diabetes, asthma and chronic obstructive airways disease. Appointments ranged from 20 minutes to 45 minutes according to individual need and patients were encouraged to contribute to their individual care plan. Condition-specific information was provided which included advice on how to recognise worsening of the condition and action to be taken.
  • The practice was committed in supporting the training of clinical staff to deliver excellent chronic disease management. For example, the practice was supporting a nurse to attain a diploma in diabetes, and the health care assistant had completed a course to enhance their skill set in supporting those patients with a long-term condition. A monthly diabetes clinic was attended by a Diabetes Specialist Nurse from the locality, to support the practice nurses in developing their skills in this condition. This also had the benefit of reducing the usual four week wait for patients with complex diabetes symptoms to be seen in the community.
  • INR monitoring was provided at the practice and within patients’ homes. INR testing measures the length of time taken for the blood to clot to ensure that patients taking particular medicines were kept safe.
  • The practice had developed their own patient advice and information leaflets including diabetes, spirometry (a breathing test), and the application of ear drops.
  • A pharmacist from the CCG’s medicines management team visited the practice weekly to assist with medicines audits, reviews of prescribed medicines, and offered prescribing advice and guidance.

Families, children and young people

Good

Updated 26 July 2016

  • Quarterly meetings were held with health visitors, school nurses and other community based agencies to safeguard children and support families in need.
  • The practice provided same day open access consultations each morning. Telephone advice was offered to parents, and appointments were provided outside of standard school hours.
  • A family planning service was provided including intra-uterine device (coil) and implant fittings. The practice also provided a sexual health clinic and emergency contraception.
  • The practice provided baby changing facilities, and there was a small play area for younger children. The practice welcomed mothers who wished to breastfeed on site, and provided a private room for them upon request.
  • The practice hosted weekly midwifery and monthly health visitor clinics.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG averages. Monitoring of these recalls was in place to keep children safe.

Older people

Good

Updated 26 July 2016

  • The practice had a higher proportion of older people registered with them compared to local and national averages. The practice had 10.1% of their patients aged 75 and over (local 7.9%; national 7.8%)
  • The practice provided personalised care for all their patients, and each patient was allocated a named GP responsible for the co-ordination of their care.
  • The practice held monthly multi-disciplinary meetings to review the needs of patients with complex needs and to review and update care plans.
  • The practice worked with a named care co-ordinator to plan and deliver care for the most vulnerable patients and those at risk of hospital admission. The practice ensured contact was made with patients discharged from hospital within three days to ensure they were safe and well.
  • The facilities were located at ground floor level with wide access corridors and spacious consulting rooms, suitable for wheelchairs and mobility scooters.
  • The practice used bespoke care plans to provide clear information on individual care plans, including patient preferences. This information sharing with out of hours’ services and other agencies provided co-ordinated care for patients, and helped to reduce the number of unnecessary hospital admissions.
  • Longer appointment times were available and home visits were available for those unable to attend surgery.
  • The practice provided care to one local residential home. A named GP provided weekly visits to the care home for continuity. The visits provided medical advice, reviews of patients’ medicines, care planning, and the discussion of any safeguarding concerns. The practice responded to any urgent patient needs on the same day.

Working age people (including those recently retired and students)

Good

Updated 26 July 2016

  • The practice provided daily same day appointments each morning on a ‘sit and wait’ basis. Telephone consultations were available each morning and afternoon which had to be booked in advance. No extended hours’ GP appointments were available.
  • The practice offered on-line booking for all GP pre-bookable appointments, and requests for repeat prescriptions. The practice provided electronic prescribing so that patients on repeat medicines could collect them directly from their preferred pharmacy.
  • Streamlined questionnaire-based were available for non-complex medicines reviews, so that the patient did not have to attend the practice.
  • The practice offered health checks for new patients and NHS health checks for patients aged 40-74.
  • The practice promoted health screening programmes to keep patients safe. For example, the practice had achieved a rate of 83.9% cervical screening for eligible women which was higher than local and national averages (77.7% and 74.3% respectively)

People experiencing poor mental health (including people with dementia)

Good

Updated 26 July 2016

  • The practice achieved 100% for mental health related indicators in QOF, which was 3.1% above the CCG and 7.2% above the national averages, with exception reporting rates generally in line with averages.
  • 97% of patients with ongoing active mental health problems had received an annual health check during 2014-15, and this was achieved with a significantly lower exception reporting rate than local and national averages.
  • 91.8% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was higher than local and national averages, with similar exception reporting rates.
  • The practice provided information to patients on how to access locally based talking therapy services.
  • The practice identified carers and sought patient consent to discuss care with their carer directly.
  • Plans were in progress for the community psychiatric nurses to provide weekly clinics at the practice to support patients experiencing poor mental health.

  • Patients could self -refer to confidential counselling sessions with Talking Mental Health which were held on at the practice

People whose circumstances may make them vulnerable

Good

Updated 26 July 2016

  • The practice provided health checks for patients with a learning disability with their practice nurse. The practice had undertaken an annual health review in the last 12 months for 57% of patients with a learning disability.
  • A more flexible appointment system was offered to vulnerable patients when required
  • The practice worked in–line with recognised standards of high quality end of life care. Palliative care was co-ordinated by a named GP working with the wider multi-disciplinary team. Bi-monthly palliative care meetings were in place between with GPs, district nurses and the Macmillan nurse. An analysis of patient deaths was undertaken for patients with cancer to ensure any learning points were considered, and ensure that best practice was shared with the whole team. The analysis included whether or not the patient had died in their preferred place.
  • The practice adopted a co-ordinated approach to care by the use of care plans, which ensured key information was shared with other providers such as the out of hours service.
  • Homeless people were welcomed to register with the practice.