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Archived: Marston Surgery Good

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Reports


Inspection carried out on 06 Feb 2019

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Marston Surgery on 3 July 2018. The overall rating for the practice was good with requires improvement for providing safe services.

From the inspection in July 2018 the practice was told they must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the practice was told they should:

  • Demonstrate the impact of the changes made following implementation of improvements to the issues highlighted in the July 2017 annual national GP patient survey and in the new GP patient survey published 9 August 2018.
  • Make efforts to improve the uptake of cervical screening so the 80% coverage target for the national screening programme is achieved.
  • Continue to identify patients who are carers and improve facilities and services available for this client group.

The full comprehensive report on the July 2018 inspection can be found by selecting the ‘all reports’ link for Marsden on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 February 2019, 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 on 3 July 2019. This report covers our findings in relation to those improvements made since our last inspection.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

The practice is rated as good overall and good for all the population groups.

We found that:

  • Infection prevention and control measures had improved. Staff had appropriate immunisation checks which were monitored by the practice. Clinical rooms had appropriate washable floors throughout.
  • The practice had increased the uptake for national screening programmes with the use of health promotion activity. The practice had identified a large percentage of its patient population were university residents that were only registered for one year. It had also identified that delays in the national screening programme administration system caused narrow timeframes to identify and see patients who were due for screening. The practice used the national screening programme prior notification lists to identify patients and invite them for screening using their own systems. This has increased the rate of patients receiving cervical screening to 79% which was in line with local and national averages.
  • The practice had continued with efforts to support carers. The practice had identified 0.3% of their practice population as carers. The practice included questions relating to caring in their registration forms and used the practice website to promote carer support. The practice had reviewed the registered carers list and had completed 24 face-to-face carers assessments. Appropriate support and referral was offered.
  • The practice was aware of the lower than average patient satisfaction scores from the GP patient survey regarding appointment availability and ease of making an appointment. They had worked with the patient participation group and improved their website to include an online booking facility to improve accessibility. The practice had also employed a workflow team to manage any online queries and messages. It was envisaged this would improve patient satisfaction over time.
  • The practice had recently agreed a contract for a new telephone system that would be implemented in the weeks following our inspection. This would include facilities for messaging, queuing and internal calling and the practice advised they expected marked improvements to patient satisfaction as a result.
  • The practice had increased their multi-disciplinary workforce to include physician’s assistants, physiotherapists, pharmacy technicians and advanced nurse practitioners. This had increased appointment capacity. Receptionists were trained to signpost patients to the most appropriate clinician. A patient survey was due to be undertaken in June 2019 to assess the impact of these changes.

There were areas where the provider should make improvements are:

  • Continue to monitor patient satisfaction scores around access to the service and embed initiatives to improve this.
  • Continue to proactively identify and support carers.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

Inspection carried out on 03 Jul

During a routine inspection

This practice is rated as Good overall. (Previous rating 10 August 2017 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Marston Surgery on 3 July 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Clinical performance data was comparable to the national and local data.
  • The practice maintained a log of the immunisation status of hepatitis B for all applicable staff. However, at the time of our inspection the practice was completing the checks of immunisation status of applicable clinical and non clinical staff in relation to other immunisations recommended by the Health and Safety at Work Act 1974 (and Public Health England (PHE) guidance).
  • Rooms at the Marston practice where clinical practice took place (minor Illness room M008 and HCA room M018) were carpeted. After the inspection the practice told us that funding had been identified through the local clinical commissioning group (CCG) and replacement washable flooring would be installed by end of September 2018.
  • Patients we spoke with told us staff had treated them with compassion, kindness, dignity and respect.
  • The practice had implemented of improvements to the issues highlighted in the July 2017 annual national GP patient survey and the new GP patient survey published 9 August 2018 had shown improvements. However, the full impact of the improvements made were yet to be demonstrated.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • Through merged governance structures (with six other practices in the region of Bedfordshire, Northamptonshire and Derbyshire), processes and systems to support governance and management were clearly set out. The governance and joint working arrangements promoted interactive and co-ordinated person-centred care.

The areas where the provider must make improvements are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. Please refer to the requirement notice section at the end of the report for more detail.

The areas where the provider should make improvements are:

  • Demonstrate the impact of the changes made following implementation of improvements to the issues highlighted in the July 2017 annual national GP patient survey and in the new GP patient survey published 9 August 2018.
  • Make efforts to improve the uptake of cervical screening so the 80% coverage target for the national screening programme is achieved.
  • Continue to identify patients who are carers and improve facilities and services available for this client group.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection carried out on 10 August 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marston Surgery on 10 August 2017. Overall the practice is rated as Requires Improvement.

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

  • There was an open and transparent approach to safety and a thorough system in place for reporting and recording significant events.
  • The practice had developed systems to minimise risks to patient safety however some systems were found to be in need of improvement.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the most recent national GP patient survey showed patients rated the practice lower than others for several aspects of care. A percentage of patients surveyed said they did not feel that they were treated with dignity and respect or involved in decisions about their care and treatment. The practice was aware of its low performance and had developed an action plan to address these issues.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Despite lower than average national patient survey results, 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.
  • We saw evidence that meetings were structured to allow for lessons to be learned and shared with staff following significant events and complaints.
  • 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The area where the provider must make improvement is:

  • Ensure care and treatment is provided in a safe way to patients. In particular, systems for reviewing patients’ medication to minimise risks associated with taking medicines that require monitoring must be improved.

The areas where the provider should make improvement are:

  • Continue to identify and support carers.
  • Continue to monitor and ensure improvement to national GP patient survey results.
  • Continue to monitor the effectiveness of the newly implemented system to transport controlled stationery between sites.
  • Ensure that newly developed systems to analyse significant events on annual basis are implemented effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice