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This report describes our judgement of the quality of care at this service. It is based on a combination of what we foundwhen we inspected, information from our ongoing monitoring of data about services and information given to us fromthe provider, patients, the public and other organisations.

Ratings

Overall rating for this service Good –––

Are services safe? Good –––

Are services effective? Good –––

Are services caring? Good –––

Are services responsive to people’s needs? Good –––

Are services well-led? Good –––

ChingChing WWayay MedicMedicalal CentrCentreeQuality Report

7 Ching WayChingfordLondonE4 8DYTel: 020 8430 7020Website: www.churchillmedical.nhs.uk

Date of inspection visit: 3 November 2016Date of publication: This is auto-populated when thereport is published

1 Ching Way Medical Centre Quality Report This is auto-populated when the report is published

Contents

PageSummary of this inspectionOverall summary 2

The five questions we ask and what we found 4

The six population groups and what we found 6

What people who use the service say 9

Areas for improvement 9

Detailed findings from this inspectionOur inspection team 10

Background to Ching Way Medical Centre 10

Why we carried out this inspection 10

How we carried out this inspection 10

Detailed findings 12

Overall summaryLetter from the Chief Inspector of GeneralPractice

We carried out an announced comprehensive inspectionat Ching Way Medical Centre on 3 November 2016. Overallthe practice is rated as good.

Our key findings across all the areas we inspected were asfollows:

• There was an open and transparent approach to safetyand an effective system in place for reporting andrecording significant events.

• Risks to patients were assessed and well managed.• Staff assessed patients’ needs and delivered care in

line with current evidence based guidance. Staff hadbeen trained to provide them with the skills,knowledge and experience to deliver effective careand treatment.

• Patients said they were treated with compassion,dignity and respect and they were involved in theircare and decisions about their treatment.

• Information about services and how to complain wasavailable and easy to understand. Improvements weremade to the quality of care as a result of complaintsand concerns.

• Patients said they found it easy to make anappointment with a named GP and there wascontinuity of care, with urgent appointments availablethe same day.

• The practice had good facilities and was well equippedto treat patients and meet their needs.

• There was a clear leadership structure and staff feltsupported by management. The practice proactivelysought feedback from staff and patients, which it actedon.

• The provider was aware of and complied with therequirements of the duty of candour.

The areas where the provider should make improvementare:

• To review how patients with caring responsibilities areidentified and recorded on the patient record systemto ensure information, advice and support is madeavailable to all.

Summary of findings


• Introduce a cleaning log to confirm that weeklycleaning of handheld clinical equipment is takingplace.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Summary of findings


The five questions we ask and what we foundWe always ask the following five questions of services.

Are services safe?The practice is rated as good for providing safe services.

• There was an effective system in place for reporting andrecording significant events.

• Lessons were shared to make sure action was taken to improvesafety in the practice.

• When things went wrong patients received reasonable support,truthful information, and a written apology. They were toldabout any actions to improve processes to prevent the samething happening again.

• The practice had clearly defined and embedded systems,processes and practices in place to keep patients safe andsafeguarded from abuse.

• Risks to patients were assessed and well managed.

Good –––

Are services effective?The practice is rated as good for providing effective services.

• Data from the Quality and Outcomes Framework (QOF) showedpatient outcomes were at or above average compared to thenational average.

• Staff assessed needs and delivered care in line with currentevidence based guidance.

• Clinical audits demonstrated quality improvement.• Staff had the skills, knowledge and experience to deliver

effective care and treatment.• There was evidence of appraisals and personal development

plans for all staff.• Staff worked with other health care professionals to understand

and meet the range and complexity of patients’ needs.

Good –––

Are services caring?The practice is rated as good for providing caring services.

• Data from the national GP patient survey showed patients ratedthe practice higher than others for several aspects of care.

• Patients said they were treated with compassion, dignity andrespect and they were involved in decisions about their careand treatment.

• Information for patients about the services available was easyto understand and accessible.

• We saw staff treated patients with kindness and respect, andmaintained patient and information confidentiality.

Good –––

Summary of findings


Are services responsive to people’s needs?The practice is rated as good for providing responsive services.

• Practice staff reviewed the needs of its local population andengaged with the local Clinical Commissioning Group to secureimprovements to services where these were identified.

• Patients said they found it easy to make an appointment with anamed GP and there was continuity of care, with urgentappointments available the same day.

• The practice had good facilities and was well equipped to treatpatients and meet their needs.

• Information about how to complain was available and easy tounderstand and evidence showed the practice respondedquickly to issues raised. Learning from complaints was sharedwith staff and other stakeholders.

Good –––

Are services well-led?The practice is rated as good for being well-led.

• The practice had a clear vision and strategy to deliver highquality care and promote good outcomes for patients. Staffwere clear about the vision and their responsibilities in relationto it.

• There was a clear leadership structure and staff felt supportedby management. The practice had a number of policies andprocedures to govern activity and held regular governancemeetings.

• There was an overarching governance framework whichsupported the delivery of the strategy and good quality care.This included arrangements to monitor and improve qualityand identify risk.

• The provider was aware of and complied with the requirementsof the duty of candour. The partners encouraged a culture ofopenness and honesty. The practice had systems in place fornotifiable safety incidents and ensured this information wasshared with staff to ensure appropriate action was taken

• The practice proactively sought feedback from staff andpatients, which it acted on. The patient participation group wasactive.

• There was a strong focus on continuous learning andimprovement at all levels.

Good –––

Summary of findings


The six population groups and what we foundWe always inspect the quality of care for these six population groups.

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

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

• The practice was responsive to the needs of older people, forexample offering emergency and routine home visitsundertaken by the patient’s usual doctor.

• Urgent appointments were available for those with enhancedneeds.

• The practice undertook ward rounds of three local nursinghomes.

Good –––

People with long term conditionsThe practice is rated as good for the care of people with long-termconditions.

• Nursing staff had lead roles in chronic disease managementand patients at risk of hospital admission were identified as apriority.

• The practice performance for diabetes related indicators wascomparable to both the Clinical Commissioning Group (CCG)and the national average.

• Longer appointments and home visits were available whenneeded.

• All these patients had a named GP and a structured annualreview to check their health and medicines needs were beingmet. For those patients with the most complex needs, thenamed GP worked with relevant health and care professionalsto deliver a multidisciplinary package of care.

• The practice provided a walking group for patients on the longterm conditions registers.

• An in house spirometry, ECG (electrocardiogram, used to checkheart rhythm and electrical activity) and INR testing service(used to help diagnose the cause of unexplained bleeding orinappropriate blood clots) was available.

• The practice regularly met with Macmillan nurses to discusspatients receiving on end of life care.

Good –––

Families, children and young peopleThe practice is rated as good for the care of families, children andyoung people.

Good –––

Summary of findings


• There were systems in place to identify and follow up childrenliving in disadvantaged circumstances and who were at risk, forexample, children and young people who had a high number ofA&E attendances. Immunisation rates were relatively high for allstandard childhood immunisations.

• Patients told us that children and young people were treated inan age-appropriate way and were recognised as individuals,and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was80%, which was comparable to the CCG and national average of81%. Appointments were available outside of school hours andthe premises were suitable for children and babies.

• We saw positive examples of joint working with midwives,health visitors and school nurses.

Working age people (including those recently retired andstudents)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 retiredand students had been identified and the practice had adjustedthe services it offered to ensure these were accessible, flexibleand offered continuity of care.

• The practice provided extended hours appointments at bothsites.

• A full range of online services were available which includedbooking routine appointments, ordering repeat prescriptionsand viewing medical records.

• A full range of health promotion and screening that reflects theneeds for this age group.

Good –––

People whose circumstances may make them vulnerableThe practice is rated as good for the care of people whosecircumstances may make them vulnerable.

• The practice held a register of patients living in vulnerablecircumstances including homeless people and those with alearning disability.

• The practice offered longer appointments for patients with alearning disability.

• The practice regularly worked with other health careprofessionals in the case management of vulnerable patients.

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

Good –––

Summary of findings


• The practice provided a Turkish advocate who was able toengage with Turkish speaking patients at risk of social isolation.

• Staff knew how to recognise signs of abuse in vulnerable adultsand children. Staff were aware of their responsibilities regardinginformation sharing, documentation of safeguarding concernsand how to contact relevant agencies in normal working hoursand out of hours.

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

• < >Mental health related indicators were comparable to both theClinical Commissioning Group (CCG) and the national average.

• The practice regularly worked with multi-disciplinary teams inthe case management of patients experiencing poor mentalhealth, including those with dementia.

• The practice carried out advance care planning for patientswith dementia.

• The practice had told patients experiencing poor mental healthabout how to access various support groups and voluntaryorganisations.

• The practice had a system in place to follow up patients whohad attended accident and emergency where they may havebeen experiencing poor mental health.

• Staff had a good understanding of how to support patients withmental health needs and dementia.

Good –––

Summary of findings


What people who use the service sayThe national GP patient survey results were published inJuly 2016.The results showed the practice was performingbelow or significantly below local and national averages.Three hundred survey forms were distributed and 144were returned. This represented 2% of the practice’spatient list.

• 55% of patients found it easy to get through to thispractice by phone compared to the national averageof 73%.

• 69% of patients were able to get an appointment tosee or speak to someone the last time they triedcompared to the national average of 76%.

• 79% of patients described the overall experience ofthis GP practice as good compared to the nationalaverage of 85%.

• 70% of patients said they would recommend this GPpractice to someone who has just moved to the localarea compared to the national average of 79%.

As part of our inspection we also asked for CQC commentcards to be completed by patients prior to our inspection.We received 12 comment cards which were all positiveabout the standard of care received. Patients said thatthey were very happy with the friendly and efficientservice and that the practice was always clean and wellmaintained.

We spoke with three patients during the inspection. Allthree patients said they were satisfied with the care theyreceived and thought staff were approachable,committed and caring. The Friends and Family Test (FFT)for September 2016 showed that 72% of participantswere either likely or extremely likely to recommend thepractice.

Areas for improvementAction the service SHOULD take to improve

• Introduce a cleaning log to confirm that weeklycleaning of handheld clinical equipment is takingplace.

• To review how patients with caring responsibilitiesare identified and recorded on the patient recordsystem to ensure information, advice and support ismade available to all.

Summary of findings


Our inspection teamOur inspection team was led by:

Our inspection team was led by a CQC LeadInspector.The team included a GP specialist adviser.

Background to Ching WayMedical CentreChing Way Medical Practice is located in Chingford, NorthLondon and is part of the Waltham Forest ClinicalCommissioning Group. Ching Way Medical Practice is partof the Churchill Health Group. It is branch practice ofChurchill Medical Centre and shares the patient list andstaff Patients are able to make an appointment at eitherthe Ching Way or Churchill Medical site. Churchill MedicalCentre was registered separately with the Care QualityCommission and was therefore inspected separately. TheChurchill Health Group has a patient list of approximately14,200. Thirty nine percent of patients are aged under 18(compared to the national practice average of 44%) and21% are 65 or older (compared to the national practiceaverage of 20%). Fifty five percent of patients have along-standing health condition.

The services provided by the practice include child healthcare, ante and post-natal care, immunisations, sexualhealth and contraception advice and management of longterm conditions.

The Ching Way Medical Practice staff team comprises a sixGP partners (two female and four male), working a total of33 sessions per week, four salaried GPs (three female andone male) working a total of 16 sessions per week, a maleGP registrar (or trainee GP) working nine sessions per week,two medical students working six sessions each (while

receiving clinical supervision), a full time female nursepractitioner, three full time female nurses, practicemanager, assistant practice manager and administrativestaff. Ching Way Medical Practice holds a Personal MedicalService (PMS) contract with NHS England.

The practice’s opening hours are:

• Monday –Friday 8:00am-6:30pm• Thursday 6:30pm-8pm (extended hours)

Appointments were available at the following times:

• Monday to Friday 8:30am – 11:30am and 2:30pm –5:30pm

Thursday (extended hours) 5:30pm to 8pm

Outside of these times patients are directed to the local outof hours provider.

In addition to pre-bookable appointments that could bebooked up to four weeks in advance, urgent appointmentswere also available for people that needed them.

The practice is registered to provide the following regulatedactivities which we inspected: treatment of disease,disorder or injury; diagnostic and screening procedures,surgical procedures, family planning and maternity andmidwifery services.

Ching Way Medical Centre had not been inspectedpreviously.

Why we carried out thisinspectionWe carried out a comprehensive inspection of this serviceunder Section 60 of the Health and Social Care Act 2008 aspart of our regulatory functions. The inspection wasplanned to check whether the provider is meeting the legal

ChingChing WWayay MedicMedicalal CentrCentreeDetailed findings


requirements and regulations associated with the Healthand Social Care Act 2008, to look at the overall quality ofthe service, and to provide a rating for the service under theCare Act 2014.

How we carried out thisinspectionBefore visiting, we reviewed a range of information we holdabout the practice and asked other organisations to sharewhat they knew. We carried out an announced visit on 3November 2016. During our visit we:

• Spoke with a range of staff (GP, practice nurse, practicemanager and administrative staff) and spoke withpatients who used the service.

• Observed how patients were being cared for and talkedwith carers and/or family members

• Reviewed an anonymised sample of the personal careor treatment records of patients.

• Reviewed comment cards where patients and membersof the public shared their views and experiences of theservice.

To get to the heart of patients’ experiences of care andtreatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

We also looked at how well services were provided forspecific groups of people and what good care lookedlike for them. The population groups are:

• Older people

• People with long-term conditions

• Families, children and young people

• Working age people (including those recently retiredand students)

• People whose circumstances may make themvulnerable

• People experiencing poor mental health (includingpeople with dementia).

Please note that when referring to informationthroughout this report, for example any reference to theQuality and Outcomes Framework data, this relates tothe most recent information available to the CQC at thattime.

Detailed findings


Our findingsSafe track record and learning

There was an effective system in place for reporting andrecording significant events.

• Staff told us they would inform the practice manager ofany incidents and there was a recording form availableon the practice’s computer system. The incidentrecording form supported the recording of notifiableincidents under the duty of candour. (The duty ofcandour is a set of specific legal requirements thatproviders of services must follow when things go wrongwith care and treatment).

• We saw evidence that when things went wrong with careand treatment, patients were informed of the incident,received reasonable support, truthful information, awritten apology and were told about any actions toimprove processes to prevent the same thing happeningagain.

• The practice carried out a thorough analysis of thesignificant events.

We reviewed safety records, incident reports, patient safetyalerts and minutes of meetings where these werediscussed. We saw evidence that lessons were shared andaction was taken to improve safety in the practice. Forexample, following an event where, following dischargefrom hospital, a patient with a known allergy wasincorrectly coded on the practice’s computer system,records showed that the practice had amended the error,discussed at a team meeting and then sent a reminder toall staff to ensure that they double checked patients’coding before entering this information onto the computersystem.

Overview of safety systems and processes

The practice had clearly defined and embedded systems,processes and practices in place to keep patients safe andsafeguarded from abuse, which included:

• Arrangements were in place to safeguard children andvulnerable adults from abuse. These arrangementsreflected relevant legislation and local requirements.Policies were accessible to all staff. The policies clearlyoutlined who to contact for further guidance if staff hadconcerns about a patient’s welfare. There was a lead

member of staff for safeguarding who was also thesafeguarding lead for the local borough. The GPsattended safeguarding meetings when possible andalways provided reports where necessary for otheragencies. Staff demonstrated they understood theirresponsibilities and all had received training onsafeguarding children and vulnerable adults relevant totheir role. GPs were trained to child protection or childsafeguarding level 3. One of the practice nurses wastrained to level 3 and the remainder of the nurses weretrained to level 2. Non-clinical staff had received level 1safeguarding training.

• A notice in the waiting room advised patients thatchaperones were available if required. All staff whoacted as chaperones were trained for the role and hadreceived a Disclosure and Barring Service (DBS) check.(DBS checks identify whether a person has a criminalrecord or is on an official list of people barred fromworking in roles where they may have contact withchildren or adults who may be vulnerable).

• The practice maintained appropriate standards ofcleanliness and hygiene. We observed the premises tobe clean and tidy. The practice nurse was the infectioncontrol clinical lead who liaised with the local infectionprevention teams to keep up to date with best practice.There was an infection control protocol in place andstaff had received up to date training. Annual infectioncontrol audits were undertaken and we saw evidencethat action was taken to address any improvementsidentified as a result. The practice held cleaningschedules for the cleaning of the building. At the time ofinspection although we were told that hand held clinicalequipment such as spirometer and ear irrigator wasbeing cleaned on a weekly basis, we noted that thepractice did not maintain a cleaning log. Since theinspection the practice has provided evidence that aprotocol and cleaning schedule are now in place.

• The arrangements for managing medicines, includingemergency medicines and vaccines, in the practice keptpatients safe (including obtaining, prescribing,recording, handling, storing, security and disposal).Processes were in place for handling repeatprescriptions which included the review of high riskmedicines. The practice carried out regular medicinesaudits, with the support of the local CCG pharmacyteams, to ensure prescribing was in line with bestpractice guidelines for safe prescribing. Blank

Are services safe?

Good –––


prescription forms and pads were securely stored andthere were systems in place to monitor their use. One ofthe nurses had qualified as an Independent Prescriberand could therefore prescribe medicines for specificclinical conditions. She received mentorship andsupport from the medical staff for this extended role.Patient Group Directions had been adopted by thepractice to allow other nurses to administer medicinesin line with legislation. Health Care Assistants weretrained to administer vaccines and medicines against apatient specific prescription or direction from aprescriber.

• We reviewed six personnel files and found appropriaterecruitment checks had been undertaken prior toemployment. For example, proof of identification,references, qualifications, registration with theappropriate professional body and the appropriatechecks through the Disclosure and Barring Service.

Monitoring risks to patients

Risks to patients were assessed and well managed.

• There were procedures in place for monitoring andmanaging risks to patient and staff safety. There was ahealth and safety policy available with a poster in thereception office which identified local health and safetyrepresentatives. The practice had up to date fire riskassessments and carried out regular fire drills. Allelectrical equipment was checked to ensure theequipment was safe to use and clinical equipment waschecked to ensure it was working properly. The practicehad a variety of other risk assessments in place tomonitor safety of the premises such as control of

substances hazardous to health and infection controland legionella (Legionella is a term for a particularbacterium which can contaminate water systems inbuildings).

• Arrangements were in place for planning andmonitoring the number of staff and mix of staff neededto meet patients’ needs. There was a rota system inplace for all the different staffing groups to ensureenough staff were on duty. Staff were flexible and willingto cover for each other at either site if the need arose.

Arrangements to deal with emergencies and majorincidents

The practice had adequate arrangements in place torespond to emergencies and major incidents.

• There was an instant messaging system on thecomputers in all the consultation and treatment roomswhich alerted staff to any emergency.

• All staff received annual basic life support training andthere were emergency medicines available in thetreatment room.

• The practice had a defibrillator available on thepremises and oxygen with adult and children’s masks. Afirst aid kit and accident book were available.

• Emergency medicines were easily accessible to staff in asecure area of the practice and all staff knew of theirlocation. All the medicines we checked were in date andstored securely.

• The practice had a comprehensive business continuityplan in place for major incidents such as power failureor building damage. The plan included emergencycontact numbers for staff.

Are services safe?

Good –––


Our findingsEffective needs assessment

The practice assessed needs and delivered care in line withrelevant and current evidence based guidance andstandards, including National Institute for Health and CareExcellence (NICE) best practice guidelines.

• The practice had systems in place to keep all clinicalstaff up to date. Staff had access to guidelines from NICEand used this information to deliver care and treatmentthat met patients’ needs.

Management, monitoring and improving outcomes forpeople

The practice used the information collected for the Qualityand Outcomes Framework (QOF) and performance againstnational screening programmes to monitor outcomes forpatients. (QOF is a system intended to improve the qualityof general practice and reward good practice). The mostrecent published results showed that the practice achieved95% of the total number of points available. The practicehad a total exception rate of 12% compared to the ClinicalCommissioning Group (CCG) average of 10% and thenational average of 9% (Exception reporting is the removalof patients from QOF calculations where, for example, thepatients are unable to attend a review meeting or certainmedicines cannot be prescribed because of side effects).

This practice was not an outlier for any QOF (or othernational) clinical targets. Data from 2014/2015 showed:

• Performance for diabetes related indicators wascomparable to the CCG and to the national average. Forexample:

▪ 77% of patients’ last blood sugar reading was withinthe target range compared to the CCG average of74% and the national average of 78%.

▪ 76% of patients’ last blood pressure reading waswithin the required range compared to the CCGaverage of 78% and the national average of 78%.

▪ The percentage of patients whose last measuredtotal cholesterol was 5 mmol/l or less was 81%,compared to the CCG average of 78% and thenational average of 81%.

▪ The percentage of patients with a record of a footexamination and risk classification was 89%,compared to the CCG average of 88% and thenational average of 88%.

• Performance for mental health related indicators wascomparable to the CCG and to the national average. Forexample:

▪ The percentage of patients with schizophrenia,bipolar affective disorder and other psychoses whohad a comprehensive, agreed care plan documentedwas 80%, compared to the CCG average of 86% andthe national average of 88%.

▪ The percentage of patients diagnosed with dementiawhose care had been reviewed in a face to facereview was 74%, compared to the CCG average of81% and the national average of 84%.

• Performance for other health related indicators werecomparable to the CCG and the national average. Forexample:

▪ The percentage of patients with atrial fibrillation withCHADS2 score of 1 who were currently treated withanticoagulation drug therapy or an antiplatelettherapy was 97%, compared to the CCG average of99% and the national average of 98%.

▪ The percentage of patients with asthma who hadhad an asthma review in the last 12 months was 77%,compared to the CCG average of 76% and thenational average of 75%.

▪ The percentage of patients with lung disease whohad had a review undertaken in the last 12 monthswas 92%, compared to the CCG average of 90% andthe national average of 90%.

The practice also used the CCG practice portal andthe health analytics portal (websites that areavailable for practices to view current statisticalinformation relevant to the local area) to benchmarkthe service they provided against others in the localarea. The system helped to identify patients that mayhave been in need of extra support that may nothave been identified through QOF and was anintegral part of the practice’s integrated careprogramme.

Are services effective?(for example, treatment is effective)

Good –––


There was evidence of quality improvementincluding clinical audit.

• We were provided with evidence of five clinical auditscompleted in the last two years; two of these werecompleted audits where the improvements made wereimplemented and monitored.

• The practice participated in local audits, nationalbenchmarking, accreditation, peer review and research.

• Findings were used by the practice to improve services.For example, an audit was undertaken in September2015 to identify the number of patients that haddementia. The result showed that 91 patients had beenidentified in the records. The practice undertook aprocess of improving the way that dementia wasidentified though the computer recording system byensuring patients were correctly coded whendiagnosed. The practice repeated the audit in December2015 and an improvement in identification wasachieved with 112 patients being identified.

Effective staffing

Staff had the skills, knowledge and experience to delivereffective care and treatment.

• The practice had an induction programme for all newlyappointed staff. This covered such topics assafeguarding, infection prevention and control, firesafety, health and safety and confidentiality.

• The practice could demonstrate how they ensuredrole-specific training and updating for relevant staff. Forexample, for those reviewing patients with long-termconditions.

• Staff administering vaccines and taking samples for thecervical screening programme had received specifictraining which had included an assessment ofcompetence. Staff who administered vaccines coulddemonstrate how they stayed up to date with changesto the immunisation programmes, for example byaccess to on line resources and discussion at practicemeetings.

• The learning needs of staff were identified through asystem of appraisals, meetings and reviews of practicedevelopment needs. Staff had access to appropriatetraining to meet their learning needs and to cover thescope of their work. This included ongoing support,

one-to-one meetings, coaching and mentoring, clinicalsupervision and facilitation and support for revalidatingGPs. All staff had received an appraisal within the last 12months.

• Staff received training that included: safeguarding, firesafety awareness, basic life support and informationgovernance. Staff had access to and made use ofe-learning training modules and in-house training.There was a culture of training and development at alllevels of the organisation and staff were encouraged tolook for areas where they would like to progress theircareer. For example the practice supported one of thenurses to train as a nurse prescriber and administrativestaff to train as healthcare assistants.

Coordinating patient care and information sharing

The information needed to plan and deliver care andtreatment was available to relevant staff in a timely andaccessible way through the practice’s patient record systemand their intranet system.

• This included care and risk assessments, care plans,medical records and investigation and test results.

• The practice shared relevant information with otherservices in a timely way, for example when referringpatients to other services.

Staff worked together and with other health and social careprofessionals to understand and meet the range andcomplexity of patients’ needs and to assess and planongoing care and treatment. This included when patientsmoved between services, including when they werereferred, or after they were discharged from hospital.Meetings took place with other health care professionals ona monthly basis when care plans were routinely reviewedand updated for patients with complex needs.

Consent to care and treatment

Staff sought patients’ consent to care and treatment in linewith legislation and guidance.

• Staff understood the relevant consent anddecision-making requirements of legislation andguidance, including the Mental Capacity Act 2005.When providing care and treatment for children andyoung people, staff carried out assessments of capacityto consent in line with relevant guidance.


Good –––


• Where a patient’s mental capacity to consent to care ortreatment was unclear the GP or practice nurseassessed the patient’s capacity and, recorded theoutcome of the assessment.

Supporting patients to live healthier lives

The practice identified patients who may be in need ofextra support. For example:

• Patients receiving end of life care, carers, those at risk ofdeveloping a long-term condition and those requiringadvice on their diet, smoking and alcohol cessation.

• Smoking cessation advice was available from a localsupport group.

The practice’s uptake for the cervical screening programmewas 80%, which was comparable to the CCG and nationalaverage of 81%. There was a policy to offer telephonereminders for patients who did not attend for their cervicalscreening test. The practice demonstrated how theyencouraged uptake of the screening programme by usinginformation in different languages and for those with a

learning disability and they ensured a female sample takerwas available. The practice also encouraged its patients toattend national screening programmes for bowel andbreast cancer screening. There were failsafe systems inplace to ensure results were received for all samples sentfor the cervical screening programme and the practicefollowed up women who were referred as a result ofabnormal results.

Childhood immunisation rates for the vaccinations givenwere comparable to CCG/national averages. For example,childhood immunisation rates for the vaccinations given tounder two year olds ranged from 88% to 95% (CCG averagerange of 78% to 90%) and five year olds from 79% to 92%(CCG average range of 69% to 89%).

Patients had access to appropriate health assessments andchecks. These included health checks for new patients andNHS health checks for patients aged 40–74. Appropriatefollow-ups for the outcomes of health assessments andchecks were made, where abnormalities or risk factorswere identified.


Good –––


Our findingsKindness, dignity, respect and compassion

We observed members of staff were courteous and veryhelpful to patients and treated them with dignity andrespect.

• Curtains were provided in consulting rooms to maintainpatients’ privacy and dignity during examinations,investigations and treatments.

• We noted that consultation and treatment room doorswere closed during consultations; conversations takingplace in these rooms could not be overheard.

• Reception staff knew when patients wanted to discusssensitive issues or appeared distressed they could offerthem a private room to discuss their needs.

All of the 12 patient Care Quality Commission commentcards we received were positive about the serviceexperienced. Patients said they felt the practice offered anexcellent service and staff were helpful, caring and treatedthem with dignity and respect.

We spoke with one members of the patient participationgroup (PPG). They also told us they were satisfied with thecare provided by the practice and said their dignity andprivacy was respected. Comment cards highlighted thatstaff responded compassionately when they needed helpand provided support when required.

Results from the national GP patient survey showedpatients felt they were treated with compassion, dignityand respect. The practice was above average for mostsatisfaction scores on consultations with GPs and nurses.For example:

• 92% of patients said the GP was good at listening tothem compared to the clinical commissioning group(CCG) average of 83% and the national average of 89%.

• 91% of patients said the GP gave them enough timecompared to the CCG average of 80% and the nationalaverage of 87%.

• 95% of patients said they had confidence and trust inthe last GP they saw compared to the CCG average of91% and the national average of 95%.

• 84% of patients said the last GP they spoke to was goodat treating them with care and concern compared to thenational average of 85%.

• 90% of patients said the last nurse they spoke to wasgood at treating them with care and concern comparedto the national average of 91%.

• 83% of patients said they found the receptionists at thepractice helpful compared to the CCG average of 83%and the national average of 87%.

Care planning and involvement in decisions aboutcare and treatment

Patients told us they felt involved in decision making aboutthe care and treatment they received. They also told usthey felt listened to and supported by staff and hadsufficient time during consultations to make an informeddecision about the choice of treatment available to them.Patient feedback from the comment cards we received wasalso positive and aligned with these views. We also sawthat care plans were personalised.

Results from the national GP patient survey showedpatients responded positively to questions about theirinvolvement in planning and making decisions about theircare and treatment. Results were in line with local andnational averages. For example:

• 84% of patients said the last GP they saw was good atexplaining tests and treatments compared to the CCGaverage of 79% and the national average of 86%.

• 80% of patients said the last GP they saw was good atinvolving them in decisions about their care comparedto the national average of 82%.

• 91% of patients said the last nurse they saw was good atinvolving them in decisions about their care comparedto the national average of 85%.

The practice provided facilities to help patients be involvedin decisions about their care:

• Staff told us that interpreting services were available forpatients who did not have English as a first language.We saw notices in the reception areas informingpatients this service was available.

• Information leaflets were available in easy read formatand also in a larger font for those patients that neededthis.

Are services caring?

Good –––


• British Sign Language services were available if patientsrequired them.

Patient and carer support to cope emotionally withcare and treatment

Patient information leaflets and notices were available inthe patient waiting area which told patients how to accessa number of support groups and organisations.Information about support groups was also available onthe practice website.

The practice’s computer system alerted GPs if a patient wasalso a carer. The practice had identified 100 patients ascarers (less than 1% of the practice list). Writteninformation was available to direct carers to the variousavenues of support available to them.

Staff told us that if families had suffered bereavement, theirusual GP contacted them or sent them a sympathy card.This call was either followed by a patient consultation at aflexible time and location to meet the family’s needs or bygiving them advice on how to find a support service.

Are services caring?

Good –––


Our findingsResponding to and meeting people’s needs

The practice reviewed the needs of its local population andengaged with the NHS England Area Team and ClinicalCommissioning Group (CCG) to secure improvements toservices where these were identified.

• The practice offered an extended hour’s clinic on aThursday evening until 8pm for working patients whocould not attend during normal opening hours.

• There were longer appointments available for patientswith a learning disability.

• Home visits were available for older patients andpatients who had clinical needs which resulted indifficulty attending the practice.

• Same day appointments were available for children andthose patients with medical problems that require sameday consultation.

• The practice provided online services which includedthe booking of routine appointments, ordering repeatprescriptions and viewing their patient records.

• A patient led walking group is provided for patients withlong term conditions that may benefit from this service.

• The practice undertook in house spirometry, ECG(electrocardiogram, used to check heart rhythm andelectrical activity) and INR testing service (used to helpdiagnose the cause of unexplained bleeding orinappropriate blood clots) testing.

• Home visits are undertaken by the patient’s usualdoctor to enable continuity of care.

• A weekly ward round of three nursing homes isundertaken.

• The practice employed a Turkish advocate.• Regular meetings are undertaken with Macmillan nurses

to discuss the care for patients on end of life care.• The practice meets regularly with the integrated care

team to discuss patients that were vulnerable.• Patients were able to receive travel vaccinations

available on the NHS as well as those only availableprivately.

• There were disabled facilities, a hearing loop andtranslation services available.

Access to the service

The practice’s opening hours were:

• Monday –Friday 8:00am-6:30pm

• Thursday 6:30pm-8pm (extended hours)

Appointments were available at the following times:

• Monday to Friday 8:30am – 11:30am and 2:30pm –5:30pm

• Thursday (extended hours) 5:30pm to 8pm

In addition to pre-bookable appointments that could bebooked up to four weeks in advance, urgent appointmentswere also available for people that needed them.

Results from the national GP patient survey showed thatpatient’s satisfaction with how they could access care andtreatment was variable compared to local and nationalaverages.

• 79% of patients were satisfied with the practice’sopening hours compared to the national average of78%.

• 55% of patients said they could get through easily to thepractice by phone compared to the national average of73%. The practice had addressed this through theinstallation of a new telephone system and the publicityof online booking services.

People told us on the day of the inspection that they wereable to get appointments when they needed them.

The practice had a system in place to assess:

• whether a home visit was clinically necessary; and

• The urgency of the need for medical attention.

For housebound patients with ongoing health needs thehome visit will be planned with their usual doctorwhenever possible in order to maintain continuity of care.In cases where the urgency of need was so great that itwould be inappropriate for the patient to wait for a GPhome visit, alternative emergency care arrangements weremade. Clinical and non-clinical staff were aware of theirresponsibilities when managing requests for home visits.

Listening and learning from concerns and complaints

The practice had an effective system in place for handlingcomplaints and concerns.

• Its complaints policy and procedures were in line withrecognised guidance and contractual obligations forGPs in England.

• There was a designated responsible person whohandled all complaints in the practice.

Are services responsive to people’s needs?(for example, to feedback?)

Good –––


• We saw that information was available to help patientsunderstand the complaints system which includedposters in the waiting area, information on the practicewebsite and a practice complaints leaflet.

We looked at 24 complaints received in the last 12 monthsand found that they had been dealt with satisfactorily andin line with the practice policy. Lessons were learnt fromindividual concerns and complaints and also from analysis

of trends and action was taken to as a result to improve thequality of care. For example, a complaint was receivedfollowing a fee being charged for private work that thepatient was not aware of at the time. A letter was sent tothe patient to explain the policy and staff were reminded toensure that patients were aware of any charges that mightbe accrued for private work undertaken.

Are services responsive to people’s needs?(for example, to feedback?)

Good –––


Our findingsVision and strategy

The practice had a clear vision to deliver high quality careand promote good outcomes for patients.

• The practice had a mission statement which wasdisplayed in the waiting areas and staff knew andunderstood the values.

• The practice had a robust strategy and supportingbusiness plans which reflected the vision and valuesand were regularly monitored.

Governance arrangements

The practice had an overarching governance frameworkwhich supported the delivery of the strategy and goodquality care. This outlined the structures and procedures inplace and ensured that:

• There was a clear staffing structure and that staff wereaware of their own roles and responsibilities.

• Practice specific policies were implemented and wereavailable to all staff.

• A comprehensive understanding of the performance ofthe practice was maintained

• A programme of continuous clinical and internal auditwas used to monitor quality and to makeimprovements.

• There were arrangements for identifying, recording andmanaging risks, issues and implementing mitigatingactions.

Leadership and culture

On the day of inspection the partners in the practicedemonstrated they had the experience, capacity andcapability to run the practice and ensure high quality care.Staff told us the partners were approachable and alwaystook the time to listen to all members of staff.

The provider was aware of and had systems in place toensure compliance with the requirements of the duty ofcandour. (The duty of candour is a set of specific legalrequirements that providers of services must follow whenthings go wrong with care and treatment).This includedsupport training for all staff on communicating with

patients about notifiable safety incidents. The partnersencouraged a culture of openness and honesty. Thepractice had systems in place to ensure that when thingswent wrong with care and treatment:

• The practice gave affected people reasonable support,truthful information and a verbal and written apology

• The practice kept written records of verbal interactionsas well as written correspondence.

There was a clear leadership structure in place and staff feltsupported by management.

• The practice held regular team meetings.

• Staff told us there was an open culture within thepractice and they had the opportunity to raise anyissues at team meetings and felt confident andsupported in doing so.

• Staff said they felt respected, valued and supported,particularly by the partners in the practice. All staff wereinvolved in discussions about how to run and developthe practice, and the partners encouraged all membersof staff to identify opportunities to improve the servicedelivered by the practice.

Seeking and acting on feedback from patients, thepublic and staff

The practice encouraged and valued feedback frompatients, the public and staff. It proactively sought patients’feedback and engaged patients in the delivery of theservice.

• The practice had gathered feedback from patientsthrough the patient participation group (PPG) andthrough surveys and complaints received. The PPG metregularly, carried out patient surveys and submittedproposals for improvements to the practicemanagement team. The practice also ran a virtual PPGwith 300 members. Suggestions given by the PPG andundertaken by the practice ranged from the installationof automatic doors to conserve heat in the winter, theprovision of a barrier at the main reception desk toensure privacy and a regular patient newsletter. Thenewsletter included health information written by theGPs, community information and information regardingPPG health initiatives such as a newly formed walkinggroup.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


• The PPG undertook a patient survey and one of theareas that the practice developed following thefeedback was the a change from all appointments beingbook on the day to a system of partial booking on theday and offering patients an appointment up to twoweeks in advance.

• The practice had gathered feedback from staff throughmonthly staff meetings and annual appraisals. Staff toldus they would not hesitate to give feedback and discussany concerns or issues with colleagues andmanagement. Staff told us they felt involved andengaged to improve how the practice was run.

Continuous improvement

There was a focus on continuous learning andimprovement at all levels within the practice. The practiceteam was forward thinking and part of local pilot schemesto improve outcomes for patients in the area. The practicewas involved in the pilot scheme for the electronicprescribing scheme (EPS) which was rolled out throughoutthe country. The practice was also involved in a pilot forprimary care providers to be able to look at laboratoryresults from secondary care through a computer systemcalled “Tquest”

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


Documents

Ching Way Medical Centre NewApproachComprehensive Report ...€¦ · 2Ching Way Medical Centre Quality Report This is auto-populated when the report is published • Introduceacleaninglogtoconfirmthatweekly