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Spinney Brook Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 21 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of Dr Bevan and Partners on 28 March 2017. This was to check that improvements had been made following the breach of legal requirements we identified from our comprehensive inspection carried out on 18 May 2016. During our inspection in May 2016 we identified a regulatory breach in relation to:

  • Regulation 12 HSCA (RA) Regulations 2014 safe care and treatment

This report only covers our findings in relation to the areas identified as requiring improvement following our inspection in May 2016. You can read the report from this comprehensive inspection, by selecting the 'all reports' link for Dr Bevan and Partners on our website at www.cqc.org.uk. The areas identified as requiring improvement during our inspection in May 2016 were as follows:

  • Ensure appropriate systems are in place for the proper and safe management of medicines including dispensing, audit, recording and destruction of controlled drugs and followed correctly and that standard operating procedures contain all the relevant information.

In addition, the practice were told they should:

  • Ensure staff receive appropriate training and appraisals; update training for dispensary staff in dispensary procedures including management of controlled drugs and update training in infection control and infection control audit.
  • Continue to identify and support carers.
  • Advise patients at the branch surgery what to do when the dispensary is closed.
  • Implement a system to provide an audit trail for blank prescriptions at the branch practice.

Our focused review on 28 March 2017 showed that improvements had been made and our key findings across the areas we inspected were as follows:

  • The practice had arranged a training session for dispensary staff in managing controlled drugs (medicines that require extra checks and special storage because of their potential for misuse) and they had put procedures in place to manage them safely. One member of staff had not yet qualified as a dispenser, and was fully supervised when dispensing controlled drugs.
  • The controlled drugs policy had been revised to include details of the NHS England Controlled Drugs Accountable Officer.
  • Controlled drugs were stored in a controlled drugs cupboard, access to them was restricted and the keys held securely.
  • There were arrangements in place for the destruction of controlled drugs, and the out of date stock we saw at our last inspection had been disposed of in the presence of an authorised witness. Records were kept in line with controlled drugs legislation.
  • We saw records of regular checks on controlled drugs stock, and a three monthly report was made to the practice clinical meeting. During one of the routine checks, staff had identified a discrepancy which had been appropriately recorded, reported and investigated. The controlled drugs procedure had been revised to reduce the risk of this type of error happening again.
  • Blank prescriptions at the branch surgery were stored securely and the practice had introduced a log of serial numbers to monitor their use in line with national guidance.
  • In the afternoons when the dispensary was closed, prescriptions and dispensed medicines could be collected by arrangement at the main surgery in Irthlingborough, or the prescription could be sent to a community pharmacy to be dispensed. The practice had taken to steps to ensure patients were aware of who to contact when the dispensary was closed.
  • The practice held a register of patients identified as carers and promoted support services available to carers and including information in patients areas in order to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 April 2017

At our comprehensive inspection on 18 May 2016, we identified breaches of legal requirements. Improvements were needed to processes and procedures to ensure the practice provided safe services.

Specifically, staff members did not record and monitor controlled drugs in line with legislation. The standard operating procedures (SOPs) did not contain all the required information and there was no evidence that controlled drugs were checked regularly. The provider had not ensured that out of date controlled drugs were disposed of regularly, and that the process for disposing of controlled drugs was followed.

During our focused inspection on 28 March 2017, we found the practice had taken action to improve and the practice is now rated as good for providing safe services.

  • The practice had arranged a training session for dispensary staff in managing controlled drugs (medicines that require extra checks and special storage because of their potential for misuse) and they had put procedures in place to manage them safely. One member of staff had not yet qualified as a dispenser, and was fully supervised when dispensing controlled drugs.
  • The controlled drugs policy had been revised to include details of the NHS England Controlled Drugs Accountable Officer.
  • Controlled drugs were stored in a controlled drugs cupboard, access to them was restricted and the keys held securely.
  • There were arrangements in place for the destruction of controlled drugs, and the out of date stock we saw at our last inspection had been disposed of in the presence of an authorised witness. Records were kept in line with controlled drugs legislation.
  • We saw records of regular checks on controlled drugs stock, and a three monthly report was made to the practice clinical meeting. During one of the routine checks, staff had identified a discrepancy which had been appropriately recorded, reported and investigated. The controlled drugs procedure had been revised to reduce the risk of this type of error happening again.
  • Blank prescriptions at the branch surgery were stored securely and the practice had introduced a log of serial numbers to monitor their use in line with national guidance.
  • In the afternoons when the dispensary was closed, prescriptions and dispensed medicines could be collected by arrangement at the main surgery, or the prescription could be sent to a community pharmacy to be dispensed. The practice had taken to steps to ensure patients were aware of who to contact when the dispensary was closed.

Effective

Good

Updated 12 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Clinical staff had the skills, knowledge and experience to deliver effective care and treatment. The nursing team had a wide range of skills and had received training in all long term conditions. Dispensary staff had gaps in knowledge regarding some procedures such as disposal of controlled drugs.
  • There was evidence of appraisals and personal development plans for clinical staff, although non-clinical staff appraisals were yet to be completed for this year. However, staff reported an open door policy at the practice and reported being able to approach the practice manager at any time if they identified training or development needs.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 12 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for all aspects of care except one where they were comparable.
  • 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 12 September 2016

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 Nene Clinical Commissioning Group to secure improvements to services where these were identified. For example, they were exploring ways with other practices to form a federation and provide better access and more extended hours in the area.
  • Patients said they found it easy to make an appointment with urgent appointments available the same day via a triage system. Patients had commented on easy access to appointments and the practice had introduced the triage system to promote this.
  • The practice had responded to patient need by assessing and reviewing the issues for patients. They had recognised the benefits of investment in specialist resources such as the advanced nurse practitioner and a counsellor to benefit patients and ensure they had access to appropriate assessment, treatment and support.
  • The practice had acknowledged the need to be proactive in child protection and establish early identification, assessment, support and monitoring of children at risk and work with other agencies to maintain this. There was evidence of identification of significant numbers of children who had been recognised as needing additional monitoring and support.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 12 September 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 and held regular meetings which included governance.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. However, there were some gaps in systems and knowledge regarding the dispensary procedures.
  • The provider 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 engaged with the practice and felt involved and listened to.
  • There was a focus on continuous learning and improvement at all levels and the practice was committed to education and involved in the training of new GPs and medical students.
Checks on specific services

People with long term conditions

Good

Updated 12 September 2016

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

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

  • The ANP carried out reviews at home for patients with long term conditions who were not able to attend the practice and developed management plans with patients to prevent admission to hospital.
  • Longer appointments 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 and ANP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 12 September 2016

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

  • The practice had good 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 and demonstrated good communication with other agencies.

  • Immunisation rates were high for all standard childhood immunisations.

  • We saw the practice had detailed information regarding all children on the safeguarding register and close links had been established with the school liaison officer, school nurse, midwife and health visitor to ensure adequate support and monitoring took place and enable early intervention.
  • 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.
  • Cervical screening rates were 79% and were comparable to those locally and nationally at 81%.
  • The practice offered a full range of contraceptive services including implants and intra-uterine contraceptive devices.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. There was a child friendly play area in the reception.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Chlamydia screening was offered for young people between 15 and 24 years.

Older people

Good

Updated 12 September 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 had employed an Advanced Nurse Practitioner (ANP) to visit care homes weekly and carry out a ward round as well as visit older housebound patients who could not attend the practice for review of their care.
  • They practice had close links with the community elderly care consultant and community health care team.

Working age people (including those recently retired and students)

Good

Updated 12 September 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.
  • The practice had an ‘information zone’ providing information and self-testing of blood pressure.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 September 2016

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

  • 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was the same as the national average.
  • 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 A&E 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 12 September 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.

  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the pro-active care team.
  • 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.
  • The practice had a dedicated safeguarding administrator to ensure important information was communicated to relevant professionals.
  • The practice had a robust approach to child protection and had implemented multi-disciplinary team meetings where there was a focus on all children at risk in all categories and proactive work was undertaken to prevent abuse and address early warning signs.
  • There were systems in place to identify potentially vulnerable patients at registration, for example service veterans.
  • The practice held a register of patients identified as carers, they had identified 133 patients as carers which represented 1.2% of the practice list.