St Mary's Medical Centre

Updated 28 September 2017

St Mary’s Medical Centre is located close to Oldham town centre. The practice provides services from a purpose built two storey building. Consulting rooms are on the ground floor only. There is a car park with space for disabled parking.

At the time of our inspection there were 4893 patients registered with the practice. The practice is a member of NHS Oldham Clinical Commissioning Group (CCG) and delivers commissioned services under the Personal Medical Services (PMS) contract. The practice is a teaching and training practice for medical students and registrars.

There are three GP partners, two male and one female and a male salaried GP. They work between four and eight sessions per week. There are three practice nurses and a healthcare assistant. All of these staff are female and work part time. There is also a practice manager and administrative and reception team.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available:

Monday: 9.00 am - 11.48 am and 3.00 pm - 5.48 pm

Tuesday: 9.00 am - 12.00 pm and 3.00 pm - 5.30 pm

Wednesday: 9.00 am - 11.48 am and 3.00 pm - 6.00 pm

Thursday: 9.00 am - 11.48 am and 3.30 pm - 5.30 pm

Friday: 9.00 am - 11.30 and 3.00 pm - 5.30 pm

Extended hours are not provided at the practice. This service is provided by the Oldham 7 day access service (GotoDoc) which provides GP appointments between 6.30 pm and 8.00 pm Monday to Friday and between 10.00 am and 2.00 pm on a Saturday and Sunday. In addition to pre-bookable appointments, urgent appointments were also available for patients that needed them.

Updated 28 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Mary’s Medical Centre on 25 July 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 25 July 2016 inspection can be found by selecting the ‘all reports’ link St Mary’s Medical Centre on our website at www.cqc.org.uk. At that inspection the practice did not have effective systems to manage the following:

• Legionella and fire safety risk assessments had not been completed.

• Complaints were not managed effectively.

• The quality of the service was not managed for the purpose of making improvements.

• Staff training was not monitored.

• The provider did not have a system to follow when a Disclosure and Barring Service (DBS) check was received provided negative information about potential employees.

• Practice specific policies were not in place for the prevention and control of infection.

• The provider did not have procedures in place to monitor all blank prescriptions, including those in printers.

Within an agreed timescale the practice submitted an action plan which demonstrated they are now meeting the requirement notices from this inspection.

We carried out this announced follow up comprehensive inspection at St Mary’s Medical Practice on 10 August 2017 to ensure the issues identified at the previous inspection had been met. The practice had addressed the breaches of regulation and was now compliant with all regulations. This report covers our findings in relation to those improvements and also additional findings at this inspection. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. For example, fire safety and the prevention of legionella.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Staff were provided with relevant training which was monitored to ensure they kept up to date with changing care practices and new ways of working.

• The provider had a system to follow when a Disclosure and Barring Service (DBS) check was received which provided negative information about potential employees.

• Practice specific policies were in place for the prevention and control of infection.

• The provider had procedures in place to monitor all blank prescriptions, including those in printers.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Patient care plans should be streamlined to ensure the copy recorded on the practice IT system was the same as the copy given to the patient.

• The practice nurse induction programme should be developed to outline staffs role and responsibilities.

• The information given to patients about how to make a complaint should include details of the ombudsman.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 September 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Data from 2015/2016 indicated that the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 58%.This was compared to the CCG average of 76% and the national average of 78%. On the day of the inspection we were given more recent data (2016/2017) to indicate this figure had improved to 63%. While we were unable to compare this to the CCG and national average for this period, it demonstrated an improvement in this area of care since the last inspection.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.  Patients who did not attend their appointments were also followed up and offered another appointment.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their individual health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health care professionals to deliver a multidisciplinary package of care.

• The data governance administrator monitored disease registers and encouraged patients to attend their annual review.  There was a personalised approach to this work and consequently the uptake of annual reviews had increased.

• Vaccination clinics were held to administer the influenza and pneumococcal vaccination to those at risk. This was also done opportunistically.

• A policy was being formulated to offer patients with long-term conditions a face to face review following an accident and emergency (A&E) attendance or non-elective admission.

• Diabetic specialist nurses were invited to participate in clinics supporting practice nurses.

Updated 28 September 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Data from 2015/2016 indicated that the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 58%.This was compared to the CCG average of 76% and the national average of 78%. On the day of the inspection we were given more recent data (2016/2017) to indicate this figure had improved to 63%. While we were unable to compare this to the CCG and national average for this period, it demonstrated an improvement in this area of care since the last inspection.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.  Patients who did not attend their appointments were also followed up and offered another appointment.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their individual health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health care professionals to deliver a multidisciplinary package of care.

• The data governance administrator monitored disease registers and encouraged patients to attend their annual review.  There was a personalised approach to this work and consequently the uptake of annual reviews had increased.

• Vaccination clinics were held to administer the influenza and pneumococcal vaccination to those at risk. This was also done opportunistically.

• A policy was being formulated to offer patients with long-term conditions a face to face review following an accident and emergency (A&E) attendance or non-elective admission.

• Diabetic specialist nurses were invited to participate in clinics supporting practice nurses.

Updated 28 September 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits by members of the practice including the practice nurse and GP’s.

• Urgent appointments for those patients with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with other health care professionals such as district nurses.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, health checks for patients over 75 year included a dementia check.

• Patients aged over 75 years had a named GP.

• The building was accessible for patients with mobility problems.

• Disabled car parking space was available.

• Vaccination clinics were held to administer the influenza and pneumococcal vaccination.

• Patients who were socially isolated and bereaved etc. were referred to Age Concern which offered a befriending service.

• The new patient questionnaire included questions about whether the patient had a carer.  Carers were signposted to other support services

Updated 28 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Telephone consultations were available.

• Appointments between 6.30 pm and 8.00 pm and 10.00 am and 2.00 pm on a Saturday and Sunday available with the Oldham 7 day access service GotoDoc.

• The practice planned to trial video consultations for the Oldham Clinical Commissioning Group.

Updated 28 September 2017

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

• The practice carried out advanced care planning for patients living with dementia. For example, data from 2015/2016 indicated that 70% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was lower than the CCG average of 82% and the national average of 84%.

• Data from 2015/2016 indicated that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 73% which was lower than the CCG average of 89% and the national average of 89%.On the day of the inspection we were given more recent data (2016/2017) to indicate this figure had improved to 98%. While we were unable to compare this to the CCG and national average for this period it demonstrated an improvement in this area of care since the last inspection.

• Data from 2015/2016 indicated that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months78% which was lower than the CCG average of 88% and the national average of 89%.On the day of the inspection we were given more recent data (2016/2017) to indicate this figure had improved to 96%. While we were unable to compare this to the CCG and national average for this period, it demonstrated an improvement in this area of care since the last inspection.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• There was a lead GP for dementia care.

• A mental health worker from the MIND organisation ran a weekly afternoon session from the practice.

• Longer appointments were available for patients with mental health issues.

Updated 28 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Telephone consultations were available.

• Appointments between 6.30 pm and 8.00 pm and 10.00 am and 2.00 pm on a Saturday and Sunday available with the Oldham 7 day access service GotoDoc.

• The practice planned to trial video consultations for the Oldham Clinical Commissioning Group.

• A mental health worker from the MIND organisation provided a weekly afternoon clinic.

• Staff used an interpretation service for patients whose first language was not English.