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Archived: Montpelier Surgery Good

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 18 April 2017

Letter from the Chief Inspector of General Practice

The practice is rated good overall and good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 15 September 2016. The overall rating for the practice was good. However, a breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. We conducted a focused inspection on 22 March 2017 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 15 September 2016 we found the following area where the practice must improve:

  • Establish appropriate security and tracking of blank prescriptions for use in printers.

  • Conduct regular fire drills.

Our previous report also highlighted the following areas where the practice should improve:

  • Continue to identify patients within the practice who are also carers.

  • Ensure drug safety updates are acted upon in a timely manner, in accordance with practice policy.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 22 March 2017 we found:

  • Arrangements were in place for the safe security and tracking of prescriptions

  • The practice conducted regular fire drills in accordance with practice policy.

We also found the following in relation to the areas where the practice should improve:

  • The practice was taking steps to identify patients within the practice who were also carers. There was information about services available to carers in the practice waiting room and on the website. Carers information packs were available at reception. The numbers of carers registered at the practice was now 72, which was an increase from 58 at the last inspection and represented more than 1% of the practice list.

  • Drug updates were acted upon in a timely manner in accordance with practice policy. There was lead GP responsible for cascading alerts and subsequent actions were recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 April 2017

The practice is now rated good for delivering safe services.

At our last inspection on 15 September 2016 we found that safety systems and processes and monitoring risks to patients were not always assessed and well managed. This was in relation to security and tracking of blank prescriptions for use in printers and carrying out regular fire drills, in accordance with practice policy.

At this inspection, we found that the practice had implemented their action plan to ensure that these issues had been addressed and that arrangements for security and tracking of blank prescriptions were now safe. Fire drills were carried out regularly and in accordance with practice policy.

Effective

Good

Updated 18 April 2017

Caring

Good

Updated 18 April 2017

Responsive

Good

Updated 18 April 2017

Well-led

Good

Updated 18 April 2017

Checks on specific services

People with long term conditions

Good

Updated 14 November 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was better than the clinical commissioning group (CCG) and national averages. For example, patients with diabetes who had a blood pressure reading in the preceding 12 months of 140/80mmHg or less was 85% which was better than the CCG average of 76% and the national average of 78%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and 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.

  • The practice had a dedicated member of staff whose role was to improve the chronic disease management recall systems and optimise work flow within the practice.

  • The GPs and practice nurse attended a two day enhanced human immunodeficiency virus (HIV) education course to improve the care of patients who were HIV positive.

  • The practice offered annual reviews to HIV positive patients and ensured immunisations such as the flu and pneumococcal vaccines were offered.

Families, children and young people

Good

Updated 14 November 2016

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • 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.

  • The practice’s uptake for the cervical screening programme was 72%, which was in line with the clinical commissioning group (CCG) average of 70% and the national average of 74%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice offered six week health checks for mothers and babies.

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

Older people

Good

Updated 14 November 2016

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

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice offered regular ward rounds and annual reviews for three local care homes for patients with complex health needs.

Working age people (including those recently retired and students)

Good

Updated 14 November 2016

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 offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • Patients were able to request a phone consultation, which was particularly convenient for patients of working age.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 November 2016

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

  • The practice performance for the management of patients diagnosed with dementia was better than local and national averages. For example 100% of these patients had received a face-to-face review within the preceding 12 months compared to the CCG average of 82% and the national average of 84%.

  • The practice performance for management of patients with poor mental health was comparable to local and national averages. For example, 90% of patients with severe and enduring mental health problems had a comprehensive care plan documented in their records within the last 12 months compared to the CCG average of 83% and the national average of 88%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

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

People whose circumstances may make them vulnerable

Good

Updated 14 November 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice offered regular ward rounds and annual reviews for a local care home for patients with a learning disability and was the dedicated GP practice for all residents. The practice had built a good relationship with the care home and showed us complimentary feedback from the management team.

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

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

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.