Archived: Selden Medical Centre

Updated 7 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Selden Medical Centre on 01 December 2015. Breaches of legal requirements were found during that inspection within the safe domain. The practice was rated as good overall, requires improvement in the safe domain and good in the effective, caring, responsive and well-led domains. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements. We undertook a focused inspection on 11 October 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and was rated as good overall and good under the safe domain. This report only covers our findings in relation to those requirements.

During the previous inspection on 01 December 2015 we found that the areas where the practice must make improvements were:

• To ensure that all staff receive training appropriate to their roles specifically in relation to the safeguarding of children and vulnerable adults and the Mental Capacity Act.

This report should be read in conjunction with the last report from 01 December 2015. The report from our last comprehensive inspection can be read by selecting the 'all reports' link on our website at www.cqc.org.uk

During this inspection we found that:

• All staff had received training in the safeguarding of children and of vulnerable adults to a level appropriate to their role. Additionally all clinical staff had received training in the Mental Capacity Act 2005.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 February 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.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less is 90%( CCG average 79.5%, national average 78%)

• The percentage of patients with diabetes on the register who have had influenza immunisation in the preceding 12 months (01/01/14 to 31/03/15) was 94.41% (CCG average 96.3%, national average 94.45%)

• Longer appointments and home visits were available when needed.

• All these patients had a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the GP team worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• There were named diabetic and respiratory nurses.

• The hospital liaison diabetic nurse held joint clinics with the diabetic nurse monthly.

Updated 25 February 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 (accident and emergency) attendances. Immunisation rates were comparable to the national averages for all standard childhood immunisations. For example immunisation rates for two year olds and under were 88.4% - 97% (national average 92.8% - 97%)

• 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 percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 82.15% (national average 81.83%)

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The health visitor regularly notified the practice of new families with under 5’s and there was a health visitor liaison link.

• Specific appointments available for post-natal and six week baby checks and these were organised by a named member of staff for liaison.

• The liaison member of staff followed up immunisation non-attenders.

• Receptionists offered appointments together if more than one person wished to be seen in the family.

Updated 25 February 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.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• A register was held of housebound patients and used to arrange flu vaccination visits, domiciliary phlebotomy, district nurse visits or GP house calls.

• Meetings were held with the proactive care team (a team consisting of representatives of community health and care agencies) every two weeks to plan care for patients at risk of unplanned hospital admission and having complex needs.

• There was good communication and links with the community matron.

• Confirmation of appointments would be sent in the post if booked over the phone, or a phone call would be made on the day of the appointment as a reminder.

• The practice held a carers register and one of the staff members was responsible for carer liaison.

Updated 25 February 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.

• Prescriptions could be ordered and appointments booked via a mobile phone app.

• Early morning and evening appointments were available.

• NHS health checks were available

• Weekend appointments for cervical screening and other health screening were available via the clinical commissioning group’s minor injury assessment and minor illness (MIAMI) clinics on site.

Updated 25 February 2016

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

• 83% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last twelve months (national average 88.5%)

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in their record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate was 91.6% (national average 88.5%)

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• It 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.

• It 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 people with mental health needs and dementia. Staff had attended a dementia friends course.

• There was dementia signage on doors in the practice.

• Patients with poor mental health had annual mental health reviews carried out.

• The practice had links with the named liaison practitioner with the local mental health provider who attended meetings at the practice

• There was a trained GP Lead for dementia.

Updated 25 February 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’ with learning disabilities.

• It looked after the health needs of patients at a local homeless project, a hostel for people recently discharged from prison and a residence for young adults with physical disability to help them learn to live in the community.

• Annual health checks and reviews were held for patients with learning disabilities and those with poor mental health.

• It offered longer appointments for people with a learning disability.

• There was an alert system on the practice computers to flag up vulnerable patients.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told vulnerable patients about how to access various support groups and voluntary organisations.

• Patients were asked if they had a carer and with their permission would make sure that the carer had all the information they needed to contact outside agencies. Carers were made aware that they could contact the practice for information that may help with the patient’s care.

• The member of staff that summarised the notes of new patients would highlight the patient to a named GP. They would identify any patient joining the practice that had a complex history, was thought to be vulnerable or was in care, on the practice computer system.

• Staff who had been trained, knew how to recognise signs of abuse in vulnerable adults and children. They 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.

• Receptionists were aware that if patients arrived for an appointment early they should alert their GP so they didn’t have to wait too long to be seen.