The Orsett Surgery Also known as Orsett Surgery

Updated 30 June 2016

Letter from the Chief Inspector of General Practice

On 14 May 2015 we carried out a comprehensive inspection of The Orsett Surgery. They were rated as good overall. They were rated as requires improvement for providing safe services and good for providing effective, caring responsive and well-led services. As a result of this inspection the practice were issued with a requirement notice for improvement.

The issues we identified were as follows;

• Staff were not clear about safeguarding procedures.

• Staff trained as chaperones were unclear about their role. Some staff had not received DBS checks and a risk assessment was not in place as to why they were not necessary.

• Procedures in place to manage medicines, including controlled drugs in use at the practice were not effective. Staff undertaking dispensing duties had not received sufficient training or supervision. Written procedures for the dispensing of medicines were incomplete. Prescription stationery was not being monitored.

• Infection control procedures required improving in relation to monitoring the quality of the cleaning and carrying out audits.

• The fire risk assessment required more detail to manage the risk of combustible cleaning material.

• There was no hearing loop to support patients with impaired hearing, no call bell in the toilet facilities for patients who might need assistance and access to the premises was difficult for patients with limited mobility.

After the inspection the practice sent us an action plan that identified the improvements they intended to make and when they would be completed.

We then visited the practice on 05 February 2016 to review the improvements made by the practice. We found that the practice had made all of the improvements required and had complied fully with the requirement notice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 July 2015

This practice is rated as good for the care of people with long term conditions. The practice had effective arrangements for making sure that people with long term conditions were invited to the practice for annual and half yearly reviews of their health and medication to ensure that their treatment remained effective. Appointments were available with the practice nurse for annual health checks and reviews for long term conditions such as diabetes and respiratory conditions including asthma and chronic obstructive pulmonary disease (COPD). When needed, longer appointments and home visits were available. For those people with the most complex needs the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 30 July 2015

The practice is rated as good for the population group of families, children and young people. Appointments could be in person or by telephone. Appointments could be booked up to six weeks in advance and walk-in appointments were available between 9am and 10.30am each day at the practice branch surgery. The practice also provided telephone triage consultations daily.

Information and advice was available to promote health to women before, during and after pregnancy. A full range of pre-conception, antenatal and postnatal care services was available. The practice monitored the physical and developmental progress of babies and young children. Appointments were made available outside of school hours wherever possible.

There were arrangements for identifying and monitoring children who were at risk of abuse or neglect. Records showed that looked after children (such as those in foster care / under the care of the Local Authority), those subject to child protection orders and children living in disadvantaged circumstances were discussed, including any issues shared and followed up at weekly GP meetings and monthly multi-disciplinary meetings. GPs and nurses monitored children and young people who had a high number of A&E attendances or those who failed to attend appointments for immunisations and shared information appropriately. Staff were trained to recognise and deal with acutely ill babies and children and to take appropriate action.

There was information available to inform mothers about all childhood immunisations, what they are, and at what age the child should have them as well as other checks for new-born babies. Staff proactively followed up patients who failed to attend appointments for routine immunisation and vaccination programmes.

Information and advice on sexual health and contraception was provided during GP and nurse appointments.

Updated 30 July 2015

This practice is rated as good for the care of older people. Patients over the age of 75 years had a named accountable GP who was responsible for their care and treatment. The practice identified patients who were at risk of avoidable unplanned hospital admissions. These patients were included on the practice’s ‘unplanned admissions avoidance’ list to alert staff to patients who may be more vulnerable. Regular multidisciplinary team meetings were held with other health and social care professionals to support patients and ensure that they received coordinated care and treatment.

The GPs carried out visits to patient’s homes if they were unable to travel to the practice for appointments. The practice provided a range of health checks for patients aged 75 years and over. Seasonal flu vaccination and shingles vaccination programmes were provided and the practice was performing well in ensuring that patients received these.

Longer appointments were available if needed. The practice also provided medicines dispensing services to patients who were unable to obtain medicines easily at a pharmacy.

The practice identified people with caring responsibilities and those who required additional support which was recorded on their patient record. Patients with caring responsibilities were invited to register as carers so that they could be offered support and advice about the range of agencies and benefits available to them.

Updated 30 July 2015

The practice is rated as good for the population group 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. Appointments could be in person or by telephone. Appointments could be booked up to six weeks in advance and walk-in appointments were available between 9am and 10.30 am each day at the practice branch surgery. The practice also provided telephone triage consultations daily.

Information about five yearly health checks for patients aged between 40 and 75 years was available within the practice and on their website. Nurse led clinics were provided for well patient health checks. The practice provided travel advice and vaccination through appointments with the practice nurse team. Information on the various vaccinations available including diphtheria, tetanus, polio and hepatitis A was available on the practice website. When patients required referral to specialist services, including secondary care, patients were offered a choice of services, locations and dates. These referrals were made in a timely way and monitored to ensure that patients received the treatments they needed.

Updated 30 July 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). People experiencing poor mental health had received an annual physical health check. The practice regularly worked with multidisciplinary teams to support people experiencing poor mental health including those with dementia. The practice provided dementia screening services and referrals were made to specialist services as required.

The practice had suitable processes for referring patients to appropriate services such as psychiatry and counselling, including The Improving Access to Psychological Therapies (IAPT) and referrals to Child and Adolescent Mental Health Services (CAMHS) as required.

The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations including MIND. Patients were referred to local counselling sessions where appropriate and patients were provided with information on how to self-refer should they wish to receive counselling.

Updated 30 July 2015

This practice is rated as good for the care of people living in vulnerable circumstances. The practice recognised the needs of people who were vulnerable such as patients from travelling communities, those with depression, alcohol or substance misuse issues, people with mental health conditions and those with learning disabilities.

All patients with learning disabilities were invited to attend for an annual health check and staff worked proactively to improve the uptake of these checks.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector organisations such as MIND. Staff knew how to recognise signs of abuse in vulnerable adults and children. Some staff had not undertaken safeguarding training and were not aware of their responsibilities to report safeguarding concerns to local agencies where this was required.