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Inspection carried out on 19/06/2019

During an inspection to make sure that the improvements required had been made

This practice is rated as good overall. At our last inspection 4 October 2018, the practice was rated as good overall, with requires improvement for providing safe services. The practice was issued with a requirement notice for Regulation 12, safe care and treatment. This was because vaccines were not stored appropriately within refrigerators in the treatment rooms and the cold chain was not maintained within the recommended temperature range. We undertook an inspection on 19 June 2019 to check the practice had made the required improvements.

At this inspection we found:

  • Improvements had been made to ensure vaccines were being recorded as being stored appropriately. A standard operating procedure for recording refrigerator temperatures had been written and implemented. The cold chain was recorded as being within the recommend temperature range and staff were aware of actions to take if temperatures were outside of the recommended range.
  • Work had been completed to review the coding of carers on the practice’s computer system. The practice had identified issues with inappropriate coding and removed 172 records. At the time of this inspection, the practice had 299 patients who were carers, which was approximately 1.5% of the practice population.
  • The practice had improved their system for ensuring patients notes were summarised in a timely way. A practice protocol was in place for summarising, although this did not include the quality assurance process. Quarterly audits were undertaken to ensure summarising was accurate, although the completion of identified actions were not documented.
  • The practice premises were managed by a private company on behalf of the landlord. The company utilised NHS property services for contract building maintenance for the whole site, only part of which was rented by the practice. The practice had formalised arrangements to ensure they were updated on the outcomes of risk assessments and work completed as a result.

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

  • Document the quality assurance system in place for summarising, in the practice summarising policy. Actions identified and undertaken as a result of the summarising audits, should also be documented.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of General Practice

Review carried out on 16 May 2019

During an annual regulatory review

We reviewed the information available to us about Stowhealth on 16 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 4 October 2018

During a routine inspection

This practice is rated as good overall. This is the second inspection of Stowhealth, at our last inspection 24 February 2015 the practice was rated as outstanding.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Stowhealth on 4 October 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. The practice worked within a partnership of 11 practices and an electronic centralised reporting system was in place to ensure shared learning and changes were made to the benefit of the population of the Suffolk Primary Care partnership.
  • The practice had reliable systems for appropriate and safe handling of medicines within the dispensary. The practice did not have reliable systems in place for the handling of vaccines. Immediately following the inspection, the practice took action to implement a safe system and to ensure no patients had received medicines that may have been compromised.

  • The practice had not ensured that all medical records were summarised in a timely manner. Immediately following the inspection, the practice submitted their plan to address the issues found.
  • The practice had not carried out an appropriate risk assessment to identify all emergency medicines that it should stock. During the inspection the practice undertook a risk assessment and ordered the additional medicines.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. The practice showed evidence of a comprehensive audit and quality management programme that was undertaken throughout the year.
  • The practice had recognised that there was a lack of specialist mental health services to support patient experiencing poor mental health but did not meet the criteria for referral. The practice employed mental health nurse (CPN) to support their patients through a difficult time. On the day of the inspection the nurse was no longer working at the practice but now through the Suffolk Primary Care these nurses will be available in the practice and across all 13-member practices.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The data from the GP patient survey showed the practice consistently was in line or above the CCG and national averages.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it. The practice operated a telephone consultation appointment system. All patients were spoken to by a clinical staff member and appointments for either acute or follow up care were arranged by the GP. Patients we spoke with told us they had easy and appropriate access to appointments.
  • The reception team had been trained as care navigators and the whole practice team had worked together to ensure patients spoke to the right person at the right time. Patients and staff had told us that this had increased the positive experience for patients.
  • The practice demonstrated a patient focused approach to providing health care. They were proactive in offering other services for the benefit of the patients, including those provided by the NHS and others from private providers. For example, NHS services included an oncology service giving chemotherapy on site, the papworth sleep clinic and Onelife Suffolk weight management and smoking cessation clinics. Private providers included a fully equipped gym where GPs could refer patients for a number of free sessions, podiatry and exercise classes.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The area where the provider must make improvements as they are in breach of regulations is:

  • Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

  • Review and improve the recording of carers to ensure they receive appropriate support.
  • Review and improve the system to ensure medical records are summarised in a timely manner.
  • Review the system to ensure the practice has clear oversight of actions identified in risk assessments to keep patients and staff safe.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Inspection carried out on 24 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We visited Stowhealth Surgery on the 24 February 2015 and carried out a comprehensive inspection. Overall the practice is rated as outstanding.

Specifically, we found the practice was outstanding for providing responsive and well-led services and services for older people, people with long-term conditions and working age people (including those recently retired). We found the practice to be good for providing safe, effective, and caring services. It was also good for providing services for families, children and young people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored and appropriately reviewed and addressed.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. There was a strong learning culture within the practice. Staff had received training appropriate to their roles and any further training needs had been identified and planned for.

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

  • The practice was safe for both patients and staff. Robust procedures helped to identify risks and where improvements could be made.

  • Information about services and how to complain was available and easy to understand.

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

  • Patients were happy with the appointment system because they were able to get telephone advice or be seen the same day. The practice offered flexibility to help meet patients’ needs for example, by arranging a call back at a time convenient with the patient. Continuity of care was promoted by providing patients with urgent appointments that day and usually with the GP who had dealt with the initial call.

  • The practice had strong visible leadership and staff felt supported by the management and were involved in the vision of providing high quality care and treatment. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice:

  • The practice provided a fully equipped gym with qualified fitness instructors to assist patients with improving their mobility, manage body weight and maintain a healthy lifestyle.

  • The practice had responded to areas highlighted in the 2013 Patient Reference Group (PRG) survey, (this is a group of patients registered with the practice who have an interest in the service provided by the practice). These included inserting evacuation chairs in the stairwells, lowering sections of the reception desk for wheelchair users and providing all clinical rooms with electric couches. Action had been taken to improve these areas including systems to review and improve the appointment system.

  • The practice had a clear vision that was shared and owned by all staff. Structured policies and processes were followed to deliver high standards of care. Performance and governance arrangements were proactively reviewed. Leadership responsibilities were delegated appropriately and staff were able to demonstrate this worked well in practice. The clinical and management team shared decision making (both clinical and non-clinical) and worked effectively through clear communication and mutual support. There was a strong culture of shared learning, achievement and improvement to ensure that patients’ needs were met.

  • The practice had won awards in recognition of its integrated approach to long term medical conditions (LTMC). The LTMC clinics were run weekly by a team of health care assistants, nurses and GPs all working together to ensure patients received a one stop medication and health condition review.

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

Importantly the provider should

  • Improve the arrangements for the security of blank prescription forms and improve the security of medicines waiting to be collected by patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice