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The Orchard Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Orchard Medical Centre on 10 May 2016. The overall rating for the practice was good with the safe domain rated as requiring improvement. The practice needed to improve their systems in infection control, emergency medicines, vaccines and blank prescription management. The provider sent us an action plan following our inspection detailing how they would improve. The full comprehensive report from the May 2016 inspection can be found by selecting the ‘all reports’ link for The Orchard Medical Centre on our website at www.cqc.org.uk.

We undertook an announced focused inspection on the 1 February 2017 to confirm that the practice had carried out their action plan to meet the legal requirements in relation to the breach of regulation 17, good governance in which areas of concern had been identified during our previous inspection on the 10 May 2016. This report covers our findings in relation to those requirements and the improvements the provider had made since our last inspection.

Overall the practice is now rated as good for all domains.

Our key findings were as follows:

  • The practice now had good governance systems in place to assess, monitor and improve the quality of the service to ensure risks to patients' health and safety were minimised. For example, the auditing and monitoring of; infection control, emergency medicines and equipment, security of prescriptions and vaccines had now been improved.

The practice had two areas where they should improve following the inspection carried out in May 2016. We also reviewed these areas at this inspection.

In May 2016 we reported the practice should ensure that all required clinical staff were trained in accordance with best practice guidance for the insertion of intrauterine devices. We found on this inspection that the GP partners had reviewed who was appropriately trained to carry on providing this service to patients following the new best practice guidance from the Faculty of Sexual and Reproductive Healthcare. There were now two GPs who had the appropriate training and were identified as appropriate to carry out these procedures.

In May 2016 we reported the practice should improve on ensuring their systems for monitoring risks to patients, such as infection control and medical emergencies, were fully embedded within the staff team and were completed consistently. We found procedures were now embedded and carried out consistently within the staff team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 February 2017

The practice now had good governance systems in place to assess, monitor and improve the quality of the service to ensure risks to patients' health and safety were minimised. For example, the auditing and monitoring of infection control, emergency medicines and equipment, security of prescriptions and vaccines had now been improved.

Effective

Good

Updated 27 February 2017

Caring

Good

Updated 27 February 2017

Responsive

Good

Updated 27 February 2017

Well-led

Good

Updated 27 February 2017

Checks on specific services

People with long term conditions

Good

Updated 5 July 2016

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

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

  • 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 worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Longer appointments and home visits were available when needed.

  • The practice undertook the Admissions Avoidance Enhanced service which identified those patients most at risk and ensured they had a care plan in place to support them to remain out of hospital.

  • The practice had appointed a pharmacist to undertake long term condition medicines reviews and to follow up patients’ post-hospital discharge.

Families, children and young people

Good

Updated 5 July 2016

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

  • There were 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. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw joint working with midwives, health visitors who were co-located at the practice.

  • The practice provided sexual health support and advice under the ‘No Worries’ scheme.

Older people

Good

Updated 5 July 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 undertook the Care Home Enhanced Service and made weekly visits to three care homes by a designated GP.

  • The practice undertook the Admissions Avoidance Enhanced service which identified those patients most at risk and ensured they had a care plan in place to support them to remain out of hospital.

Working age people (including those recently retired and students)

Good

Updated 5 July 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.

  • Same day appointments were available and the practice opened on Saturday morning for routine appointments.

  • The practice had specialist nurses trained in minor illness management.

  • The practice provided a minor injury service.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 July 2016

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

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice were part of a joint working dementia care project with other practice and healthcare providers.

  • 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 accident and emergency 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 5 July 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 homeless people and 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.

  • 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.