Green Street Green Medical Centre

Updated 1 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 15 March 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach of regulation 17(2) (b) Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this desk-based focussed inspection on 19 October 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Green Street Green Medical Centre on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

• Risks to patients were assessed and well-managed, including those related to electrical equipment checks, fire safety and infection control.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 December 2016

This population group was rated as requires improvement in our comprehensive inspection carried out on 15 March 2016. In our recent inspection we are satisfied that the issues identified in our previous inspection were resolved and we changed the rating to good.

Updated 25 April 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 urgent care and A&E attendances.

• Immunisation rates were relatively high 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, and we saw evidence to confirm this.

• The practice worked closely with health visitors and routinely informed them of all new family registrations.

• The practice’s uptake for the cervical screening programme was 88%, which was above the CCG average of 84% and the national average of 82%.

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

Updated 25 April 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice performed advanced care planning and End of life care plans and supported patients who have expressed a wish to die in their own home.
• The practice had a dedicated Patient Liaison Officer (PLO) who worked with the elderly, vulnerable and frail patients. They contacted patients immediately after discharge from Accident and Emergency (A&E) or an unplanned admission to ascertain if they needed any support and also made follow-up calls in three months’ time. They acted as a contact point for these patients and for patients over 75 years of age and provided administrative support for doctors by sending out unplanned admissions care plans.

Updated 25 April 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.

• The practice provided well person checks and NHS health checks.

• The practice nurses provided a comprehensive travel vaccination service.

Updated 25 April 2016

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

• The number of patients with dementia who had received annual reviews was 94% which was above the Clinical Commissioning Group (CCG) average of 84% and national average of 84%.

• 94% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 84% and national average of 88%.

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

• The practice 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.

• The practice 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 patients with mental health needs and dementia.

• The practice had access to a counsellor who provided sessions at the surgery where necessary.

Updated 25 April 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 living in vulnerable circumstances including homeless people, travellers and those with a learning disability. These patients were flagged in their clinical system.

• The practice offered longer appointments for patients with a learning disability.

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

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how 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 in normal working hours and out of hours.

• The practice had a white board on which the clinicians recorded the names of patients if they had any concerns and discussed these patients with the lead clinician for safeguarding. These concerns were then collated and discussed with the health visitors.