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Inspection Summary


Overall summary & rating

Good

Updated 23 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Katie Parkinson on 18 January 2017. The overall rating for the practice was good with requires improvement for safe.

The full comprehensive report from the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Katie Parkinson on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 June 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 on 18 January 2017;

  • Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

The areas identified as requiring improvement during our inspection in January 2017 were as follows:

  • Ensure ongoing management of controlled drugs in line with legislation.
  • Ensure repeat prescriptions are signed prior to medicines being given to patients.
  • Complete a risk assessment of emergency medicines including the need to carry additional emergency medicine stock.

In addition, the practice were told they should:

  • Consider reviewing the process for identifying significant events and near misses.
  • Record actions taken in relation to safety alerts.
  • Ensure that systems are implemented to assess the risk of and to prevent, detect and control the spread of infection including routine audit processes.
  • Ensure an appropriate system is in place for the safe use of blank prescriptions.
  • Complete a periodic review of practice specific policies.

Overall the practice is now rated as good in all areas.

Our focused inspection on 14 June 2017 showed that improvements had been made and our key findings across the areas we inspected were as follows:

  • The controlled drugs standard operating procedure had been reviewed and was in line with legislation. The controlled drugs register was appropriately maintained including accurate records of stock levels.
  • The provider had implemented a repeat prescribing policy and arrangements were in place to ensure prescriptions were issued appropriately.
  • The provider had completed a risk assessment of emergency medicines and had updated their emergency medicine stock.
  • The process for identifying significant events and near misses had been improved.
  • The provider maintained a log of safety alerts and recorded actions taken to improve safety in the practice.
  • Systems and processes to assess the risk of and to prevent, detect and control the spread of infection had been reviewed and the practice had completed an infection prevention and control audit.
  • An appropriate system was in place for the safe use of blank prescriptions.
  • The provider had undertaken a review of their policies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 June 2017

At our comprehensive inspection on 18 January 2017, we identified breaches of legal requirements. Improvements were needed to processes and procedures to ensure the practice provided safe services.

Specifically, the standard operating procedure in place for the safe management of controlled drugs did not fully cover the activities taking place at the practice. Balance checks for controlled drugs were not being carried out and the stock level in the controlled drugs register for one medicine was incorrect. In addition, the register was not always completed accurately when medicines were collected by patients/carers. Repeat prescriptions were not signed before they were dispensed and given to patients. The practice had not risk assessed the need to carry additional emergency medicine stock.

During our focused inspection on 14 June 2017, we found the practice had taken action to improve and the practice is now rated as good for providing safe services.

  • The controlled drugs Standard Operating Procedure (SOP) had been reviewed to ensure it covered all the activities taking place at the practice. The SOP was in line with legislation. The practice completed a weekly check of stock levels for controlled drugs and maintained accurate records of this. The practice maintained clear records of the required information when medicines were collected by patients/carers.
  • The practice had implemented a repeat prescribing policy and arrangements were in place to ensure prescriptions were issued appropriately.
  • A risk assessment of emergency medicines had been completed and the practice had updated their emergency medicine stock.

Effective

Good

Updated 21 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were in line with the average for the locality and compared to the national average in areas relevant to the practice.
  • 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 members.
  • Staff worked with other health care professionals and school leads to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 21 March 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey results published in July 2016 showed the practice was above local and national averages for several aspects of care. For example, 93% said the last GP they saw was good at involving them in decisions about their care compared to the CCG average of 81%, and the national average of 84%.
  • 97% said the last nurse they saw or spoke to was good at involving them in decisions about their care, compared to the CCG average of 86%, and the national average of 87%.
  • The practice offered flexible appointment times based on individual patient needs.
  • 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 easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 21 March 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and East and North Hertfordshire Commissioning Group to secure improvements to services where these were identified. For example, the practice provided a dispensary service for patients who were pupils and staff members at the school.
  • Patients said they found it easy to make an appointment with the principal GP and there was continuity of care, with urgent appointments available 24 hours a day, seven days a week.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had close working arrangements in place with an on-site counsellor and physiotherapist.

Well-led

Good

Updated 21 March 2017

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • The practice was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for identifying notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice worked closely with all relevant school leads and produced a health report on an annual basis.
Checks on specific services

People with long term conditions

Good

Updated 21 March 2017

The practice is rated as good for the care of people with long-term conditions.

  • Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice provided diabetes and asthma clinics.
  • The practice had three patients on their diabetes register. All of these patients had a record of their blood pressure, cholesterol, record of a foot examination and vaccination against influenza.
  • 72% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable the local CCG and national average of 75%.
  • Patients with a long-term condition had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 21 March 2017

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

  • 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.
  • Immunisation rates were high for all standard childhood immunisations.
  • There were eight week post-natal checks for mothers and their children.
  • A range of contraceptive and family planning services were available.
  • The practice’s uptake for the cervical screening programme was 83% which was comparable with the local average of 83% and national average of 82%.
  • Appointments were available on the same day and outside of school hours.

Older people

Good

Updated 21 March 2017

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

  • The practice was responsive to the needs of older people and offered home visits and urgent appointments when required.

Working age people (including those recently retired and students)

Good

Updated 21 March 2017

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 providing good access to care and treatment. Patients could contact the practice via email to arrange an appointment. The principal GP was also contactable on a mobile telephone and the practice provided a text messaging service, as well as a full range of health promotion and screening that reflects the needs of this age group.
  • Extended appointment times were available to patients each Saturday.
  • The practice provided a dispensary service for staff members at the school.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 March 2017

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

  • The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
  • The practice had three patients on their mental health register. All of these patients had an agreed care plan.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The practice worked closely with the school’s counsellor and the local child and adolescent mental health service (CAMHS) which included referrals to the local eating disorder service.

People whose circumstances may make them vulnerable

Good

Updated 21 March 2017

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

  • The principal GP held weekly meetings with the child protection team at the school and worked with other health care professionals in the case management of vulnerable patients.
  • Vulnerable patients had been told how to access support groups and voluntary organisations.
  • Staff had accessed safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.