The Avenues Medical Centre

Updated 21 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 20 October 2015. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 – safe care and treatment.

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 – good governance.

• Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 – fit and proper persons employed.

We undertook this focused inspection on 9 June 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting 'all reports' link for The Avenues Medical Centre on our website at www.cqc.org.uk

From the inspection on 20 October 2015, the practice were told they must:

• Improve recruitment arrangements and all necessary employment checks for all staff.

• Complete risk assessments for the full environment. Additionally, blinds on the windows and the blind loop cords were safe and secured as these could potentially be a choking hazard to small children when attending the surgery. Refer to Estates and Facilities Alert (EFA/2015/001 issued 26 January 2015).

• Implement a system of reporting incidents without fear of recrimination and monitor learning from outcomes of analysis, patterns and trends of incidents.

• Monitor the prevention and control of infection.

• Complete health and safety risk assessments on the environment to reduce the risk of harm to patients.

• Review the practice facilities in respect of disabled access.

• Ensure systems are in place for identifying and monitor the completion of training for all staff in order for them to carry out their duties effectively and safely.

• Implement a clear defined leadership structure and business planning arrangements to provide effective succession planning.
• Complete risk management and assessments for the access and safety of the building premises for patients with limited mobility.

We found that on the 9 June 2016 the practice now had improved systems in place.

• Records we looked at confirmed that staff recruitment checks had been completed.

• We saw that health and safety risk assessments had been completed on the practice premises and environment including for patients with limited mobility and assessment adjustments to the blinds.

• The practice policy and procedures had been updated to include a mechanism for all staff to record incidents and concerns without fear of recrimination and staff we spoke to were clear about their duties in relation to this.

• We saw that the practice had completed hand washing audits and cleanliness checks. Additionally, a recent infection control audit had been commissioned and action points identified. Some of the action points were completed and some were in the process of completion.

• Records we looked at confirmed training for all staff had been updated and a responsible lead member of staff was allocated the duty to monitor training progress.

• We saw records that defined key leaderships roles in the practice and staff we spoke with understood their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

These patients had a regular review with either the GP and/or the nurse to check their health and medication. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients were encouraged to manage their conditions and were referred to health education and other in-house services when necessary, for example a dietician. Longer appointments and home visits were available when needed. Patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 January 2016

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

Updated 7 January 2016

The practice offered proactive, personalised care to meet the needs of the older people in its population group, The practice offered home visits and usual doctor appointments to improve continuity of care. The practice had regular contact with community nurses and participated in meetings with other healthcare professionals to discuss any patient concerns.

Updated 7 January 2016

The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible. For example, the practice opened early evenings until 6.30pm for those people who could not attend during normal opening hours. A dedicated on-call GP was available for emergency telephone advice. The practice also offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 7 January 2016

Of patients experiencing poor mental health 100% had received an annual physical health check. 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 advanced 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 (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 7 January 2016

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They had carried out annual health checks and longer appointments were available for people with a learning disability and 100% of these patients had received a follow-up.

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. Staff had been trained 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.