Thameside Medical Practice - Childs & Partners

Updated 6 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 13 April 2016. A breach of regulation 17 (2)(a)(e) Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found, as the practice had not completed any full-cycle audits. After the comprehensive inspection, the practice submitted evidence to show that they were now meeting the requirements of regulation 17.

During the initial inspection we also found areas where the practice should make improvements. We found that they had processes in place to monitor that all permanent staff were up to date with professional registrations and essential training, but this did not include long term locum staff; the practice responded promptly to all complaints, but did not include information about advocacy organisations or the Health Service Ombudsman in their responses; the practice had identified 28 patients who were carers, which represented less than 1% of their practice list; the practice had completed an infection control audit, but had not produced an action plan to address areas identified for improvement.

We undertook this desk-based focussed inspection on 19 December 2016 to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Thameside Medical Practice on our website at www.cqc.org.uk.

Overall the practice was rated as Good following the comprehensive inspection, however they were rated as requiring improvement for effective services. Following the desk-based review we found that the practice is now rated as good for providing effective services.

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

• The provider had completed two full cycle audits, which demonstrated improvements in the care provided to patients.

• The practice had processes in place to monitor that all staff, including locum staff, were up to date with training and professional registrations.
• The practice ensured that their responses to patient complaints included contact details for the NHS complaints advocacy organisation and for the Health Service Ombudsman.
• The practice had identified seven further carers, bringing the total number of carers to 35; whilst this was an improvement, the proportion of carers identified was still less than 1% of the total patient list.
• The practice had undertaken and recent infection control audit and had addressed the areas identified for improvement.

The areas where the practice should make improvement are:

• They should continue to identify patients with caring responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 7 October 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.
• Overall the practice had achieved 99% of the total Quality Outcome Framework (QOF) points for diabetes indicators, compared with an average of 90% locally and 89% nationally. The percentage of patients with diabetes who had a record of well controlled blood pressure in the preceding 12 months was 80%, which was comparable to the CCG average of 79% and the national average of 78%; the proportion of these patients with a record of a foot examination and risk classification in the preceding 12 months was 92% (CCG average 91%, national average 88%), and the percentage of diabetic patients who had received influenza immunisation was 97% (CCG average was 90% and national average was 94%).
• 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.

Updated 7 October 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.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 87%, which was better than 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, health visitors and school nurses.

Updated 7 October 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.
• Longer appointments were available for older people who needed them.
• The practice held regular multi-disciplinary meetings with the community palliative care team and community nursing team to discuss the needs of elderly patients.

Updated 7 October 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.

Updated 7 October 2016

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

• Performance for mental health related indicators was higher than the CCG and national averages, with a total QOF achievement of 100% compared to a CCG and national average of 92%; and overall exception reporting for mental health indicators was also better than average at 5% (CCG average 8%, national average 11%). The percentage 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 was 100% (with no exceptions), compared to a CCG average of 92% and a national everage of 88%.
• The practice had carried-out a face to face review in the past 12 months of 85% of patients with dementia, which was comparable to the CCG and national averages of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients 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 and had training in these areas.

Updated 7 October 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.
• 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.