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Archived: Oundle Good Also known as Dr Stovin & Partners

Inspection Summary


Overall summary & rating

Good

Updated 22 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oundle Medical Practice on 7 June 2016. Overall the practice is rated as good.

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

  • The appointment system was flexible and ensured that patients who requested to be seen on the same day were.

  • The practice had good facilities including for those with reduced mobility.

  • Information about services and how to complain was available. The practice sought patient views about improvements that could be made to the service, including having a patient participation group (PPG).

  • The practice proactively managed care plans for vulnerable patients and had effective management strategies for patients at the end of their life.

  • The practice had a number of policies and procedures to govern activity; however, the oversight to ensure that they were reviewed timely needed to be improved.

  • Systems to reduce risks to patient safety for example, where in place, however, the practice had not undertaken a legionella risk assessment. An infection control audit had been undertaken; this audit did not contain sufficient detail and needed to be improved.

  • There was a leadership structure, staff felt supported by the management team and were an integral art of the running of the practice.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

The areas where the provider must make improvements are:

  • Ensure that staff who undertake chaperone duties have received a disclosure and barring check (DBS) or that a written risk assessment is in place.

In addition the provider should;

  • Review the infection control policy and audit tool used ensuring that it is robust and meets the standards as outlined in The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance.

  • Review the monitoring of the fridge temperatures ensuring that comments and actions as appropriate are taken should the temperature not be within the required range.

  • Ensure that access to the dispensary is restricted to authorised staff only.

  • Improve the record keeping of medicines stock levels in the dispensary.

  • Ensure that all electric equipment is tested or risk assessed and is safe to use.

  • Proactively identify and offer support to carers.

  • Ensure that the risk assessment for legionella testing is completed and any actions taken.

  • Improve the management oversight of significant events to ensure trends can be identified to encourage improvement

We saw an area of outstanding practice;

  • Due to the geographical location of the practice, they are required to engage with more than one safeguarding and health visiting team .The practice identified over five years ago that this could sometimes delay appropriate responses. The practice holds quarterly meetings at the practice and representatives attend these meetings from all state schools in the area, the police, GPs, and nurses. Representatives from Service Six (mental health services for adults and children), and an Early Help co-ordinator attend. The practice told us that this had ensured that the multi-disciplinary team were able to identify concerns and respond in a timely way. This is a robust way to ensure that children who may be at risk and their families are kept safe and given appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 March 2017

At the last inspection on 7 June 2016 we found that:

  • Non-clinical staff who undertook chaperone duties had not received a Disclosure and Barring Service (DBS) check and there was no written risk assessment in place.

  • There was infection control policy in place. However, the audit undertaken in September 2015 lacked sufficient detail and was not robust, for example, identified actions did now show who should take action and by when.

  • Staff regularly reviewed and documented fridge temperatures; however, if the readings were outside of the safe range, they did not record action taken.

  • Security arrangements around the dispensary needed to be improved.

  • Stock levels and expiry dates of medicines were checked, however, there was no evidence to show how frequently.

  • Some electrical equipment required updated safety checks.

  • The practice had identified less than 1% of the patients as carers; the practice recognised that this needed to be improved.

  • A legionella risk assessment had not been undertaken.

  • The management did not log the significant events that had been recorded and as a result, could not identify trends that may have developed.

Our focused inspection on 8 February 2017 found that:

  • All non-clinical staff who undertook chaperone duties had received a Disclosure and Barring Service (DBS) check.

  • The infection control audit had been completed, but the action plan still needed to be improved as it did not include who should take action and by when. The GP partner was aware of this and had planned to take action shortly after the inspection.

  • Staff were regularly documenting fridge temperatures and action had been taken when the temperatures were out of range, for example, when completing a stock check.

  • The security measures for the dispensary had been reviewed and access was only given to authorised staff.

  • Stock levels and expiry dates of medicines were checked and documented monthly.

  • All electric equipment had been tested or risk assessed as safe to use

  • The practice had identified less than 1% of the patients as carers. However the practice had a proactive approach to identification and support of carers.

  • The practice had completed a legionella risk assessment in July 2016 but had not implemented a monitoring system for water temperatures.

  • The practice had a proactive approach to the management, discussion and disseminationof significant events and had implemented a spreadsheet log.

This report should be read in conjunction with the full inspection report from 7 June 2016.

Effective

Good

Updated 22 July 2016

The practice is rated as good for providing effective services.

Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Data showed patient outcomes were in line with other practices in the locality. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing mental capacity and promoting good health.

Staff had received training appropriate to their roles; additional training requests were identified, and where appropriate provided. There was evidence of appraisals and personal development plans for all staff.

Staff worked with multidisciplinary teams including community nurses, health visitors, and school nurses. The practice had 226 patients who had been identified as vulnerable and as a result of joint working, a written care plan was held in 220 of those patient’s medical records and the patients received an annual review.

For those patients recently discharged from hospital, the practice nurse contacted the patients within two days of arriving home. The nurse checked that the patient understood any changes to their medication that the hospital may have made.

There were 32 patients on the register for patients with a learning disability. All of these patients had been reviewed by the GPs in the past 12 months.

Caring

Good

Updated 22 July 2016

The practice is rated as good for providing caring services.

The GP national patient survey data published in January 2016 showed that patients rated the practice above the national average in many aspects of care, for example 97% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 96% and the national average of 95%.

The practice told us that they prioritised patient centred care. The percentage of patients who usually had an appointment or spoke with their preferred GP was 48% compared with the CCG average of 61% and the national average of 59%. The practice told us that they offered personalised lists and covered each other for leave. On occasions, the practice used locum GPs, these GPs were known to patients, as they regularly worked at the practice. There was a duty team who covered any requests for medical attention on the day, the practice thought this may have influence this data.

Patients told us they were treated with compassion, dignity, and respect and they were involved in care and treatment decisions. We saw that staff treated patients with kindness and respect and in a way that was individual to those patients that needed extra support.

The practice had identified less than 1% of their patients as carers and provided them with a carer’s pack which gave information including details of support groups.

Responsive

Good

Updated 22 July 2016

The practice is rated as good for providing responsive services.

Practice staff described how they were aware of the needs of their practice population, and tailored their care and services accordingly.

The practice had reviewed the demand for appointments and had developed a duty team using GPs and nurses to see patients on the day if requested. Telephone consultations and home visits were available for those that requested them.

The premises were suitable for patients with limited mobility, the practice provided wheelchairs for those that needed them.

There was a complaints system in place that was fit for purpose. The complaints received had been dealt with in a timely and appropriate manner.

Well-led

Good

Updated 22 July 2016

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. Staff were clear about the vision and their responsibilities in relation to it.

There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity, however, the management oversight of these needed to be improved.

An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk, however, this needed to be improved.

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 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 patient participation group was active.

There was a focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 22 July 2016

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

Nursing staff had roles in chronic disease management; data showed that patient outcomes were similar when compared with other practices in the locality. Patients that had attended appointments had a structured annual review to check that their health and medication needs were being met.

The practice employed a liaison nurse who ensured that patients received appropriate re-calls and follow up.

Home visits were available to those patients who could not attend the surgery.

Longer appointments were available and could be booked by patients if required. Practice staff followed up patients who did not attend their appointments by telephone.

Families, children and young people

Good

Updated 22 July 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 patients who had a high number of A&E attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. Young children were given priority appointments for urgent needs.

The practice had 850 young people, who were borders at the local school, registered. The practice had systems in place which ensured access to GPs and nurses was timely and confidential for young people.

Appointments were available outside of school hours and Saturdays. The premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors, and school nurses.

Older people

Good

Updated 22 July 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. Home visits were available for those unable to attend the practice. Continuity of care was maintained for older people through a stable GP workforce and personalised patient centred care.

The practice provided visits to local care homes.

Patient’s medicines were delivered to their home by the dispensary staff.

The practice regularly reviewed attendances at the accident and emergency department to ensure that those patients identified as vulnerable to admission were reviewed.

We saw evidence that the practice had worked to the Gold Standards Framework for those patients with end of life care needs.

Working age people (including those recently retired and students)

Good

Updated 22 July 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, including 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 reflected the needs for this age group. The practice did not restrict patients to certain appointment times to attend for their annual reviews; patients who worked were able to book at times that were convenient to them. Appointments on a Saturday and telephone consultations were available for those patients who wished to seek advice from a GP. NHS health checks were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 July 2016

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

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

Staff told us that 67% of patients with dementia had received advance care planning and had received appropriate reviews. These patients had a named GP and continuity of care was prioritised for them.

Same day appointments and telephone triage with a GP was offered to ensure that any health needs were quickly assessed for this group of patients.

The practice employed a counsellor who offered appointments to patients who needed support through a difficult. Staff at the practice told us that patients found this beneficial as they could be seen at the practice.

The school doctors and nurses had easy access to the GPs; this included any concerns that they may have had regarding the mental health of school children.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had knowledge on how to care for patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 22 July 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 those with a learning disability. It offered longer appointments and carried out annual health checks.

The practice told us that 100% of patients with a learning disability had received an annual review.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw the practice provided vulnerable patients with information about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse or neglect 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.

Practice staff were intuitive to the needs of this group of patients and demonstrated that they had a personalised approach to helping them. Phlebotomy appointments were available at the practice.

The GPs were proactive in giving their personal telephone numbers, to patients that were nearing the end of their lives. The GPs told us that they believed in continuity of care for their patients and their relatives during this difficult time. The practice told us that in the past six months 26 patients had died, of these 21 died in their preferred place of care.