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The Orchard Partnership, The Old Orchard Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 19 May 2017

Letter from the Chief Inspector of General Practice

When we visited The Orchard Partnership, The Old Orchard Surgery

on 28 September 2016 to carry out a comprehensive inspection, we found the

practice was not compliant with the regulation relating to good governance. Overall

the practice was rated as good.

We found the practice required improvement for the provision of well-led

services because:

  • The practice governance systems, specifically the communication

    systems, did not always operate effectively or consistently.

  • The practice did not ensure that learning from complaints,

    significant events and alerts were adequately shared with all appropriate

    staff.

We also said the practice should:

  • Review the safeguarding policy to ensure it includes reference

    to the legal framework for safeguarding.

  • Ensure the practice’s comprehensive business continuity plan

    includes contact numbers for staff.

  • Ensure all staff receives an appraisal every 12 months.

  • Ensure they have adequate systems in place to ensure all

    emergency medicines are in date and suitable to use.

We undertook an announced focused inspection on 27 April 2017 to

ensure  the practice was meeting the

regulation previously breached. For this reason we have only rated the location

for the key question to which this relates. This report should be read in

conjunction with the full report of our inspection on 31 August 2016, which can

be found on our website at www.cqc.org.uk.

Our

key findings were as follows:

  • The practice had implemented a new communication policy and

    procedure to ensure communications, including learning events, complaints and

    significant events were shared appropriately across their four sites.

     

  • The practice had revised their procedures to ensure learning was

    shared effectively across all sites.

  • The practice

    had updated its business continuity plan to include all staff contact numbers

    and their safeguarding policy to ensure it included reference to the legal

    framework for safeguarding.

  • The practice had revised their governance arrangements surrounding

    the management of emergency medicines to ensure they were all in date and

    suitable for use.

  • All

    staff had received an appraisal in the last 12 months.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • Risks to patients were assessed and well managed.

  • The safeguarding policies clearly outlined who to contact for further guidance if staff had concerns about a patient’s welfare. However, the policy made no reference to the legal framework for safeguarding.

  • An unexpected death had been discussed by clinical staff but not recorded as a significant incident and there was no evidence any learning had been shared with the other clinicians working from other sites.

  • The practice could not evidence that all learning from significant events had been shared with all appropriate staff.

  • The practice had a

    comprehensive business continuity plan but it did not include contact numbers for staff.

Effective

Good

Updated 14 December 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.

  • 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.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • The practice had a policy on confidentiality for teenagers which included consent and how an individual’s competency to make informed consent was assessed.

  • Not all staff had received an appraisal within the last 12 months, however we saw the ones that were overdue had been scheduled within four weeks of our inspection.

Caring

Good

Updated 14 December 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 almost all aspects of care. For example, 99% of patients said the GP was good at listening to them compared to the clinical commissioning group (CCG) average of 92% and the national average of 87%.

  • Feedback from patients about their care and treatment was consistently positive.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 14 December 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 clinical commissioning group (CCG) to secure improvements to services where these were identified. For example, the practice worked with the CCG and other local practices to establish an Elderly Care Facilitator service in the local area. One of the aims of this service was to reduce emergency admissions and we saw data that showed the practice had a low rate of non-elective admissions compared to the CCG average.

  • The practice was able to provide pharmaceutical services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy premises.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice offered  online services, text messaging and email communication.

  • All branches had a 24 hour blood pressure monitor and the practice had a 24 hour ECG monitor.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. However, the practice systems for sharing learning from complaints with staff and other stakeholders was not used consistently.

Well-led

Good

Updated 19 May 2017

When we visited The Orchard Partnership, The Old Orchard Surgery

on 28 September 2016 to carry out a comprehensive inspection, we found the

practice required improvement for the provision of well-led services because:

  • The practice governance systems, specifically the communication

    systems, did not always operate effectively or consistently.

  • The practice did not ensure that learning from complaints,

    significant events and alerts were adequately shared with all appropriate

    staff.

We undertook a focused follow up inspection of the service on 27

April 2017 to review the actions taken by the practice to improve the quality

of care and to confirm that the practice was now meeting legal requirements. We

saw evidence that;

  • The practice had implemented a new communication policy and

    procedure to ensure communications, including learning events, complaints and

    significant events are shared appropriately across their four sites.

  • The practice had revised their procedures to ensure learning was

    shared effectively across all sites. They had introduced a twice yearly

    governance meeting for all GPs and senior management, a twice yearly, half-day

    governance meeting for all staff and a quarterly newsletter for learning and

    development topics.

The

practice is now rated as good for providing well-led services.

Checks on specific services

People with long term conditions

Good

Updated 19 May 2017

The provider had resolved

the concerns for well-led identified at our inspection

on 28

September 2016

which applied to everyone

using this practice, including this population group. The population group

ratings have been updated to reflect this.

Families, children and young people

Good

Updated 19 May 2017

The provider had resolved

the concerns for well-led identified at our inspection

on 28

September 2016

which applied to everyone

using this practice, including this population group. The population group

ratings have been updated to reflect this.

Older people

Good

Updated 19 May 2017

The provider had resolved

the concerns for well-led identified at our inspection

on 28

September 2016

which applied to everyone

using this practice, including this population group. The population group

ratings have been updated to reflect this.

Working age people (including those recently retired and students)

Good

Updated 19 May 2017

The provider had resolved

the concerns for well-led identified at our inspection

on 28

September 2016

which applied to everyone

using this practice, including this population group. The population group

ratings have been updated to reflect this.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 May 2017

The provider had resolved

the concerns for well-led identified at our inspection

on 28

September 2016

which applied to everyone

using this practice, including this population group. The population group

ratings have been updated to reflect this.

People whose circumstances may make them vulnerable

Good

Updated 19 May 2017

The provider had resolved

the concerns for well-led identified at our inspection

on 28

September 2016

which applied to everyone

using this practice, including this population group. The population group

ratings have been updated to reflect this.