Madeley Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (The practice was rated as Good at our previous inspection on 9 January 2015).

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Outstanding

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Madeley practice on 1 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learnt from them and improved their processes. However, we found risk assessments had not always been completed to mitigate some potential risks.

• The practice provided a holistic approach to assessing, planning and delivering care and treatment to patients. They introduced innovative approaches to care which they had shared locally and nationally to influence the delivery of care and treatment.

• The practice had developed innovative ways of reducing A&E attendance and unplanned admissions for older and vulnerable patients through the development of an elderly care facilitator (ECF).

• The practice not only provided routine health promotion advise at patient annual health reviews but specifically targeted population groups to deliver effective and appropriate health promotion advise.

• The practice had developed a care template to support clinicians to recognise and diagnose sepsis in children.

• The practice had identified 235 patients as carers (3.4% of the practice list) through assessments carried out by the elderly care facilitator and self-referral forms available within the practice. The practice provided a weekly carer’s clinic to advise them of the support and allowances available to them, and sign posted them to other areas of support.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• The practice worked proactively with the voluntary sector and the patient participation group to meet the needs of their patients.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• GPs held leadership roles within the Clinical Commissioning Group (CCG). We saw that the knowledge and experiences they gained from these roles were embedded in the practice’s culture.

We saw four areas of outstanding practice:

• The practice had developed innovative methods to reduce the number of visits to A&E or unplanned hospital admissions for older and vulnerable patients. A&E attendances for patients aged 75-84 years over a rolling 12 month period had fallen from 93 to 80 and unplanned hospital admission rates had fallen from 150 to 112. The practice had developed a door hanger to provide a concise summary of patients’ details and needs if they were taken to hospital, led on the development and implementation of the elderly care facilitator (ECF) across the Newcastle-under-Lyme locality and were developing an extensivist model of care to provide earlier interventions. Their work on the care of older patients and a frailty tool had been published in a national medical journal.

• The practice offered a teenager clinic targeted at 15-16 year olds. Fifty-four per cent of teenagers invited to the clinic had taken up the offer to attend and were provided with an assessment of their health and mental health wellbeing. They were also offered sexual health advice. If a student was experiencing poor mental health they were supported by the practice and/or signposted to other services.

• The practice provided care and treatment for patients living in a secure unit for young adults experiencing poor mental health and/or a severe learning disability. The practice provided weekly ward rounds at the unit, ‘flu immunisations and targeted health promotion groups, for example, smoking cessation.

• The practice was not only proactive in managing, monitoring and improving outcomes for its own patients but it shared its learning locally and nationally within primary care. For example, a practice nurse was a member of a university research group that had shared their findings with the Clinical Commissioning Group (CCG). They published their findings in a professional nursing journal regarding the benefits to the health economy in the use of tap water rather than sterile water for the cleansing of non-surgical wounds.

The area where the provider must make improvements as they are in breach of a regulation are:

• Ensure care and treatment is provided in a safe way to patients. In particular, review and complete a risk assessmentto demonstrate how risks to patients will be mitigated in the absence of recommended emergency medicines at the branch practice.

The areas where the provider should make improvements are:

• Complete a risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury.

• Implement a system to track blank prescriptions used in printers throughout the practice.

• Update the practice’s complaints leaflet and policy informing patients of how they can complain to NHS England. Update patient response letters of include details of the Parliamentary and Health Service Ombudsman.

• Review the Care Quality Commission (Registration) Regulations 2009 to support their understanding of incidents that are notifiable to the Care Quality Commission.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice