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Inspection Summary


Overall summary & rating

Good

Updated 7 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Meadows Surgery on 23 May 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for The Meadows Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • There were effective arrangements in place to assess, monitor, manage and mitigate risks in respect of health and safety. These included systems for addressing Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts; and reviewing patients’ medicines.
  • Effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care. In particular, systems were in place to assess, monitor and improve the quality and safety of the service, including those for up to date record keeping, such as for staff training; and there was a rolling programme quality improvement, such as completed cycles of clinical audits.
  • Sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed to meet the fundamental standards of care and treatment. In particular, staff had received and had a record of appropriate training relevant to their role, including infection prevention and control and safeguarding adults and children. Effective arrangements were in place to assess the competency of dispensary staff.
  • A risk assessment had been completed regarding the location of the vaccine storage fridge to ensure appropriate infection prevention and control.
  • Effective arrangements were in place for the security of blank prescription stationery when clinical rooms were not in use.
  • Arrangements for communication and records had been improved to ensure learning from complaints and incidents was shared and all actions were completed.
  • Arrangements for management & leadership had been improved to ensure all staff have clarity of role, these were embedded in teams and adequate capacity and contingency arrangements for absence were in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 December 2017

At our inspection on 23 May 2017, we found:

  • The practice had systems, processes and practices to minimise risks to patient safety, however, we found that some were not implemented effectively. These included systems for addressing Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts; security of prescriptions; and reviewing patient’s medicines.
  • Staff demonstrated that they understood their responsibilities and had received training on safeguarding children and vulnerable adults relevant to their role. However, we found gaps in the records of staff training including in infection prevention and control; and safeguarding adults and children.
  • The provider should review arrangements including those for assessment of the competency of staff in the dispensary; infection prevention and control in relation to the location of the vaccine storage fridge; and for the security of blank prescription stationery.

At this inspection on 14 November 2017, we found:

  • There were effective arrangements in place to assess, monitor, manage and mitigate risks in respect of health and safety. These included systems for addressing Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts and reviewing patients’ medicines.
  • Sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed to meet the fundamental standards of care and treatment. In particular, to staff had received and had a record of appropriate training relevant to their role, including infection prevention and control; and safeguarding adults and children.
  • Effective arrangements were in place to assess the competency of dispensary staff.
  • A risk assessment had been completed regarding the location of the vaccine storage fridge to ensure appropriate infection prevention and control.
  • Effective arrangements were in place for the security of blank prescription stationery when clinical rooms were not in use.

Effective

Good

Updated 26 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework,

    where this was recorded,

    showed patient outcomes were at or above average compared to the national average.

  • The practice participated in the Dispensary Services Quality System (DSQS) to monitor, audit and improve dispensary services for patients.

  • Staff were aware of current evidence based guidance.

  • Clinical audits were carried out, h

    owever, none were found to be completed cycles of clinical audits that demonstrated quality improvement.

  • Staff had the skills and knowledge 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.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 26 July 2017

The practice is rated as good for providing caring services.

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

  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was accessible.

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

Responsive

Good

Updated 26 July 2017

The practice is rated as good for providing responsive services.

  • The practice was able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy.
  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example, the practice provided sessions on mindfulness techniques to patients in order to address the long waiting times for access to talking therapies services.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • 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.
  • Information about how to complain was available and evidence from seven examples reviewed showed the practice responded quickly to issues raised. However, learning from complaints was not shared with staff and other stakeholders.

Well-led

Good

Updated 7 December 2017

At our inspection on 23 May 2017, we found:

  • A governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. However, some arrangements had not been implemented effectively including those to assess, monitor and improve the quality and safety of the service such as clinical audits; and reviews of patients’ medicines.
  • The partners encouraged a culture of openness and honesty. However, the practice did not have effective systems to ensure all notifiable safety incidents were shared and action was taken.
  • There was evidence of learning and improvement at all levels and staff training was built into staff rotas. However, we found gaps in the records of staff training.
  • The provider should review arrangements including those regarding sufficient management capacity and contingency arrangements for management absence to ensure effective leadership; and arrangements for communication and records to ensure learning from complaints and incidents is shared and all actions were completed.

At this inspection on 14 November 2017, we found:

  • Effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care. In particular, systems were in place to assess, monitor and improve the quality and safety of the service, including those for up to date record keeping, such as for staff training and a rolling programme quality improvement, such as completed cycles of clinical audits.
  • Arrangements for management & leadership had been improved to ensure all staff have clarity of role, these were embedded in teams; and adequate capacity and contingency arrangements for absence were in place.
  • Arrangements for communication and records had been improved to ensure learning from complaints and incidents was shared and all actions were completed.
Checks on specific services

Older people

Good

Updated 7 December 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 23 May 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People with long term conditions

Good

Updated 7 December 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 23 May 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Families, children and young people

Good

Updated 7 December 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 23 May 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Working age people (including those recently retired and students)

Good

Updated 7 December 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 23 May 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People whose circumstances may make them vulnerable

Good

Updated 7 December 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 23 May 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 December 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 23 May 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.