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The Orchard Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 5 July 2016

Letter from the Chief Inspector of General Practice

We had previously inspected this GP practice in August 2014 as part of our new inspection programme pilot to test our approach going forward.

The outcome from inspection Aug 2014 was that the provider should:

  • Identify a lead for infection prevention and control.

  • Review their appointment process to improve patient’s access to appointments with GPs.

  • Review their systems to ensure timely referral to other services.

  • Introduce a patient participation group (PPG) to seek feedback from patients about the way the practice runs.

We carried out an announced comprehensive inspection at The Orchard Medical Centre 10 May 2016. Overall the practice is rated as good, however, we found some areas of concern within the safe domain which is rated as requires improvement.

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

  • Risks to patients were assessed and well managed.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice was proactive in assessing patient access to the service and sourcing innovative solutions such as the employment of a practice pharmacist.
  • Some patients said they were able to make an appointment with a named GP; there were urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure with robust underpinning systems which supported the day to day activity of the practice.
  • Staff felt supported by management and there was a positive learning culture for staff development.
  • The practice proactively sought feedback from staff and patients through the patient participation group and patient surveys, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • The practice must ensure procedures are fully embedded bychecking their implementation, specifically in relation to the system for ensuring the safe storage of medicines which required refrigeration, prescription management,the process of audit of infection control measures and emergency equipment checking records.

The areas where the provider should make improvement are:

  • All practice staff should follow best practice guidance for updating training for the insertion of intrauterine devices.

  • The practice should ensure that clinical results are reviewed in a timely way following receipt by the practice.

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 5 July 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.

Caring

Good

Updated 5 July 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 several aspects of care.

  • 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 5 July 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 South Gloucestershire Clinical Commissioning Group to secure improvements to services where these were identified. The practice were part of a joint working dementia care project with other practice and healthcare providers.

  • The practice was part of the self-referral to physiotherapy service co-ordinated by the One Care Consortium.

  • Some patients said they found it easy to make an appointment with a named GP there were urgent appointments available the same day. Access was constantly monitored by the practice and changes made to meet patient demand.
  • 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. The practice had been successful in significantly reducing the number of complaints made to them.

Well-led

Good

Updated 5 July 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 governance meetings.

  • 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, we found there was a lack of oversight of how systems were implemented such as those for auditing areas of practice.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • 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 active.

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.