Clifton Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clifton Medical Centre on 17 February 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed with the exception of those relating to recruitment checks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently and strongly positive.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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 and complied with the requirements of the Duty of Candour.

We saw some areas of outstanding practice:

• Clifton Medical Centre formed and is the centre for is a unique and specialist centre for the management of weight problems with a multidisciplinary approach to reducing and maintaining weight loss. This service was open to all patients in the Rotherham clinical commissioning group (CCG). The RIO service was commissioned by NHS Rotherham as its specialist tier of intervention for adults with weight management problems, as part of the overall NHS Rotherham Healthy Weight Strategy. One of the GPs had a specialist interest in obesity (GPwSI)  and a number of the practice staff had received specific training related to this service. A wide range of equipment had been provided to support patients, such as gym equipment. There were positive documented outcomes for patients and financial savings for the NHS. This service has been replicated at several sites around the UK.

• The practice had a dedicated long term conditions (LTC) team led by a GP who had dedicated time for this area of practice. The team also included two nurses with specific training in this area. They had identified the top 5% of patients, just over 600 patients, at the most risk of unplanned hospital admissions using a recognised risk tool. These patients had detailed assessments and care plans which included carer’s assessments. Care needs were monitored and reviewed regularly. The practice had good systems in place to monitor patients with long term conditions, for example, the hospital discharge letters were collated with the LTC register. A search was conducted twice a week to check if any patients on the LTC register had been discharged from hospital. Patients told us they were well supported by this team and were called regularly for reviews.

• The practice had developed a safety programme for housebound patients with atrial fibrillation (AF). The practice had made sure that all patients with AF had been assessed for the risk of stroke using a risk tool, had received appropriate medication and had ensured this decision was regularly reviewed and monitored. They had also ensured all patients with AF who were prescribed warfarin had alert cards issued and families and carers knew what to do in an emergency. The practice had developed a form for recording necessary information when tests used to monitor the effects of warfarin were performed in patients own home using Near Patient Testing systems. This form and its use across Rotherham had been adopted by Rotherham NHS Trust.

• The practice ensured patients had relevant information and were able to be involved in their care. Information leaflets relating to complaints, health checks and smear tests were available in easy to read formats and were available in the practice and on the website. Information about hand hygiene had been translated into a number of languages and displayed close to patient hand hygiene facilities. Information about services available had been provided for children on their 14th birthday and the practice website had specific information relating to issues for young people such as bullying and drugs.

The areas where the practice must make improvements are:

• The practice had not ensured they had obtained all the necessary recruitment checks to ensure the person was of good character prior to employment. For example, the practice had not obtained references for a locum GP and a receptionist.

The areas where the practice should make improvements are:

• Ensure items are stored appropriately to aid effective cleaning of the floors at the branch surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice