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Inspection Summary


Overall summary & rating

Good

Updated 17 February 2017

We carried out an announced comprehensive inspection at Ormskirk House Surgery on the 22nd October 2015. The overall rating for the practice was good and Safe required improvement. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Ormskirk House Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 19 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 22 October 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our key findings were as follows:

  • The practice had addressed the issues identified during the previous inspection.

  • They had provided fire risk assessments and environmental risk assessments with regular inspections carried out by their health and safety advisors. Staff had undertaken fire training.

  • They have implemented an audit sheet in each clinical room undertaken on a monthly basis in line with checking medication to ensure that no out of date stock was stored.

  • All training records had been reviewed to ensure that all staff had evidence of updated training relevant to their role. Training had been updated with safeguard training for all staff.

  • They had shared incidents of risk and complaints with all staff to help improve shared learning within the team.

  • The appointment system had been reviewed. They had increased more online bookable appointments and advertised online access and promote the service. They provided pre bookable appointments for two weeks in advance for GP’s and had a number of “on the day” appointments available for GP’s of choice.

  • Policies and procedures had been reviewed to include written guidance to cover ‘Business continuity plans’ and ‘Governance systems’ within the practice to help mitigate risks of health and safety within the practice.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 February 2017

The practice is rated as good for providing safe services. Evidence was provided as part of this desk based review to show that required improvements had been implemented. The practice had ensured staff had access to fire risk assessments and environmental risk assessments. They undertook regular inspections with their health and safety advisors. They have implemented audits for each clinical room to ensure that no out of date stock was stored. All training records had been reviewed to ensure that all staff had evidence of updated training relevant to their role including fire training and safeguarding. Policies and procedures had been reviewed to include written guidance to cover ‘Business continuity plans’ and ‘Governance systems’ within the practice to help mitigate risks of health and safety within the practice.

Effective

Good

Updated 17 February 2017

Caring

Good

Updated 17 February 2017

Responsive

Good

Updated 17 February 2017

Well-led

Good

Updated 17 February 2017

Checks on specific services

People with long term conditions

Good

Updated 3 December 2015

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment and screening programmes. The practice contacted these patients to attend annual reviews to check that their health and medication needs were being met. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs with their community matron. The practice managed a warfarin clinic to enable patients to attend the clinic which they found convenient.

Families, children and young people

Good

Updated 3 December 2015

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Immunisation rates were comparable and sometimes exceeded local CCG benchmarking for all standard childhood immunisations. The practice monitored any non-attendance of babies and children at vaccination clinics and reported any concerns they had identified. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding. However, some of the practice staff had not received updates to their safeguarding training. One GP with level 3 training took the lead for safeguarding. Staff put alerts onto a patient’s electronic record when safeguarding concerns were raised. Patient information sign posted young people to sexual health services in the building which was easily accessible to their patients. Urgent access appointments were available for children and appointments after school hours including three late nights a week provided extended hours to more convenient appointments. The staff sent out ‘congratulations cards’ to new parents to help inform them of the services available. The practice had facilities for baby feeding, promoting breast feeding and provided baby changing facilities.

Older people

Good

Updated 3 December 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

There was an up to date registers of patients’ health conditions and this information was used to plan reviews of health care and to offer services such as vaccinations for flu and shingles.

The practice staff met with the community matron and multi-disciplinary professionals on a regular basis

to provide support and access specialist help when needed.

The practice carried out home visits and reviewed patients who lived at home and those people who lived in care homes.

Working age people (including those recently retired and students)

Good

Updated 3 December 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this group 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 offered online prescription ordering and an online appointment services. Patients could book appointments in person, on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice offered drop in clinics for services such as flu vaccinations, maternity clinics and smoking cessation. They also held a flu vaccination clinic each Saturday morning. Health checks were offered to patients who were over 40 years of age to promote patient well-being and prevent any health concerns.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 December 2015

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

The practice maintained a register of patients with mental health problems in order to regularly review their needs and to carry out annual health checks. They had 79 patients on the Mental Health Register with up to 61% of patients having already agreed with their care plan up to October 2015. The practice staff liaised with other healthcare professionals to help engage these patients to ensure they attended reviews. The practice were able to refer patients to the ‘Mental Health Assessment Team’ in accordance with each person’s individual circumstances.

People whose circumstances may make them vulnerable

Good

Updated 3 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. The practice had a shared care clinic running with the local ‘Addaction Service’ (drug support organisation). They had 10 patients registered for support with drug related issues and reviewed these patients regularly within the shared care scheme. 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. However they had not all received up to date safeguarding training.