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Dr C P Hughes and Partners Good Also known as Wallingford Medical Practice


Inspection carried out on 09/07/2019

During an inspection looking at part of the service

We carried out an inspection at Dr C P Hughes and Partners on 9 July 2019.

This inspection was carried out because the practice had breached a regulation at their last inspection in October 2018 and had told us, via an action plan, that they had addressed the concerns that led to the breach. Our monitoring of the practice also identified improvement in management oversight of processes and procedures. We therefore focused on the following key questions: Was the practice providing effective and well-led services.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: Was the practice providing safe, caring and responsive services.

At this inspection we found the practice had addressed the concerns and breach of regulation found in October 2018. We have rated the practice as good for provision of effective services. The practice had maintained appropriate management and governance arrangements and is also rated good for provision of well-led services.

We have rated this practice as good overall and good for all population groups.

We found that:

  • Patients received effective care and treatment that met their needs.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • There were clear plans for practice development to accommodate an expected increase in registered patients arising from housing developments in the area.
  • There was an increased quota of clinicians increasing the working time in response to succession planning and resilience programme to ensure safe practice.
  • There were clear leadership roles and a culture of quality improvement was evident within the staff team.

Whilst we found no breaches of regulations, the provider should:

  • Continue to review processes for recalling women who had not taken part in the cervical cancer screening programme. With a view to increasing uptake.
  • Review the sustainability of the revised procedure for exception of patients with long term conditions from monitoring and follow up of their conditions.

Details of our findings and the evidence supporting the change in rating are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 9 October 2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection January 2015 rating – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr CP Hughes and Partners on 9 October 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had clear systems to manage risks to patients and staff. When incidents occurred, the practice learned from them and improved their processes.
  • The practice did not consistently monitor the effectiveness and appropriateness of the care it provided to ensure treatment was always appropriate. National data indicators showed there was high performance but there was also high exempting of patients from national data submissions.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they could access care when they needed it.
  • There was an improved focus on learning and improvement since 2017.
  • The practice continuously reviewed the needs of its patient population and adapted processes to improve services for its population.

The areas where the provider must make improvements are:

  • Identify, assess and mitigate risks to patient care where this is required to ensure safe and effective care is always delivered.

Additionally the provider should:

  • Review the processes for monitoring high risk medicines.
  • Identify whether staff and monitoring processes in the dispensary require additional support and oversight.
  • Ensure learning from dispensing errors is always identified and acted on and that the monitoring of medicine’s fridges follows relevant guidance.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 28/01/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr AR Vernon and Partners at Wallingford Medical Practice, Reading Road, Wallingford, Oxfordshire OX10 9DU on 28 January 2015.

Overall the practice is rated as good.

Specifically, we found the practice to be good for all areas including all the population groups.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

  • 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
  • The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

  • The practice had an effective and efficient leadership structure which included future practice planning. All staff shared the practice objectives to deliver high quality person centred care. There was a very strong quality and educational ethos in the practice through reporting and analysis of significant events and its audit programme.
  • The patient participation group, known as the Wallingford patients in partnership (PIP) worked closely with the practice through monthly meetings. The PIP had organised a well-advertised and attended practice open day in 2014. This was now scheduled as an annual event. A representative of the PIP was recently involved in the interviews for a new GP partner.
  • The practice had installed floor level wash basins to facilitate dressings changes for patients with leg and foot ulcers.

However there were areas of practice where the provider needs to make improvements.

The provider should

  • Ensure all medicines management procedures are followed consistently and the controlled drugs procedures include the disposal process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 10 July 2014

During a routine inspection

Dr A R Vernon and Partners, also known as Wallingford Medical Practice is located in purpose built premises in a semi-rural area in the grounds of Wallingford Community Hospital. The practice has six GP partners and four associate GPs. It provides primary medical services to approximately 16000 registered patients. The practice dispenses prescriptions to approximately 3300 patients.

The practice serves a population which is more affluent than the national average. It also has a higher proportion of patients over the age of 40 years compared to the local Oxfordshire Clinical Commissioning Group (CCG) and national average and lower in the 15-34 year age group.

We visited the practice location at Wallingford Medical Practice, Reading Road, Wallingford, Oxfordshire, OX10 9DU.

We spoke with eight patients and 19 staff during the inspection. We contacted the local clinical commissioning group, NHS England area team and local Healthwatch to seek their feedback about the service provided by Wallingford Medical Practice. We also spent time reviewing information that we hold about this practice.

We found the provider was in breach of the two Regulations: Requirements relating to workers and Supporting workers.

The practice operated from premises that were clean and well maintained. Systems were in place to report and learn from incidents to improve patient safety. However, we did not see an analysis of incidents overall to identify themes or trends. Staff were aware of how to respond appropriately if they suspected abuse in children or adults, although training in safeguarding adults had not been provided. We found a Disclosure and Barring Service (DBS) check was not in place for one nurse and there were no DBS risk assessments for three reception staff. The practice had policies and procedures in place regarding the handling of medicines. We found the practice could not be assured that non-refrigerated medicines were stored within their recommended temperature ranges. Emergency procedures were in place to respond to medical emergencies.

Systems were in place to ensure evidence based practices including national and local guidelines were used and monitored through audits. The practice nurses were trained and experienced in providing diabetes and asthma care to ensure patients with these long term conditions were regularly reviewed and supported to manage their conditions. Staff were supported to undertake core training relating to their role. However, we found two of the nursing staff felt training opportunities could be improved and dispensary staff did not receive regular update training.

We spoke with eight patients during the inspection and reviewed five comment cards. Patients were very positive about the care they received. Negative feedback from patients we spoke with and via practice surveys related to difficulty to contacting the practice to obtain appointments. We observed staff were respectful in their interactions with patients in a way that preserved their dignity and confidentiality. Information for patients on the complaints procedure was also available on the practice website and booklet. All the patients we spoke with said they had never had cause to complain about the care they received from the practice.

The practice operated a flexible appointment system which involved a duty GP to ensure all patients who needed to be seen the same day were accommodated. The practice had made some improvements to the appointment system as a result of patient feedback.

GPs were very positive about the education and training offered by the practice. GPs were aware of what action to take if they judged a patient lacked mental capacity to give their consent. They told us they recorded best interest decisions, involved carers and sought specialist advice if needed. We found all nursing staff had not received training in the Mental Capacity Act 2005.

Staff expressed pride in the practice and described a supportive team environment where individual roles were valued.

The practice considered the needs of older people in the delivery of the service. The GPs involved patients and family in discussions before completion of the do not attempt cardiopulmonary resuscitation form. GPs were aware of what action to take if they judged a patient lacked the mental capacity to give their consent and they acted appropriately.

The practice supported patients with long term conditions to manage their health, care and treatment. The practice nurses were trained and experienced in providing diabetes and asthma care to ensure patients with these long term conditions were regularly reviewed and supported to manage their conditions.

Specific services for mothers, babies, children and young people included weekly antenatal clinics, baby immunisation clinics and baby development clinics.

The practice offered weekly Saturday morning surgeries for routine and urgent appointments, to accommodate the needs of working age people and commuters.

Staff were familiar with the needs of patients with learning disabilities and supported them, for example, by reminding them to attend appointments. One of the practice nurses taught the carers of patients with learning disabilities to administer insulin to facilitate their independence.

The practice was working towards the joint Oxfordshire dementia plan to increase awareness and improve identification of patients at risk of dementia

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.