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Dr's Morgan, Taubman and Hawdon Good Also known as Sixpenny Handley & Chalke Valley Practice

Inspection Summary


Overall summary & rating

Good

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focussed follow up inspection at Drs Nodder Morgan and Taubman on 8 March 2017. This inspection was to follow up on action taken after we inspected on 17 September 2015. At the inspection on 17 September 2015 the overall rating for the practice was good but we rated the safe domain as requires improvement. The full comprehensive report on the September 2015 inspection can be found by selecting the ‘all reports’ link for Drs Nodder Morgan and Taubman on our website at www.cqc.org.uk .

This inspection was an announced focused inspection carried out on Wednesday 8 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 September 2015. This report covers our findings in relation to the requirement and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings from this inspection were as follows:

  • Failsafe recruitment processes had been introduced to ensure pre-employment references were obtained and risk assessments introduced for staff assessed as not requiring a disclosure and baring service (DBS) pre-employment checks.

  • Medicines in the practice and dispensary continued to be managed well and had been further improved in relation to the ordering of controlled drugs.

  • The management of significant events at the practice continued to be managed well and trends had been identified which showed positive outcomes regarding the care of patients who were at the end of life.

  • Adult safeguarding policies had been improved immediately following the last inspection and were now based on current practice guidelines set by the Wessex area team.

  • The procedure for the insertion of intrauterine coils had been amended to align with practice guidance set out by the Royal College of Obstetricians and Gynaecologists.

  • The infection and prevention and control processes and environmental health and safety risk assessments continued to be managed well.

  • Systems were in place to maintain and monitor equipment in the practice was well managed.

  • Arrangements were in place to monitor staffing numbers and skill mix and included the introduction of locality carers to provide care for end of life and vulnerable patients.

  • Effective arrangements were in place to manage emergencies and incidents.

We saw one outstanding aspect of care:

The practice had been recognised by healthcare professionals and members of the local community for providing a high standard of care and treatment for end of life care. The GPs worked effectively with the district nursing teams to provide continuity of care and prompt symptom relief for patients at the end of their life in the rural community. The practice had received positive feedback from palliative care hospital consultants and many letters of thanks from patients’ relatives. The GPs reviewed end of life care as positive significant events which had identified effective team work, prompt pain relief and respecting patient’s wishes of where they chose to die. The practice had employed locality carers to help with the social needs of these patients and the lead GP for palliative care shared their personal mobile telephone number with district nurses and patient’s relatives so continuity of care could be provided in addition to the out of hours service provider. The practice sent relatives letters of the anniversary of the patients death and practice staff often attended patient funerals. Records for the use of locality carers showed that these staff had made 97 visits saving the Clinical Commissioning Group (CCG) £5,400 over a six month period.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 April 2017

The practice is rated as good for providing safe services.

Since the last inspection in September 2015 there had been improvements in the arrangements in how risks were assessed and managed. Issues from the last inspection included; insufficient staff recruitment checks, controlled drug ordering processes, review of adult safeguarding policy and not following guidance set out by the Royal College of Obstetricians and Gynaecologists when inserting intrauterine coils.

An action plan was sent to CQC explaining how these issues would be resolved. At this inspection in March 2017 we found evidence that improvements had been introduced promptly after the September 2015 inspection.

On this inspection we found:

  • Failsafe recruitment processes had been introduced to ensure pre-employment references were obtained and risk assessments introduced for staff assessed as not requiring a disclosure and baring service (DBS) pre-employment checks.
  • Medicines in the practice and dispensary continued to be managed well and had been further improved in relation to ordering controlled drugs.
  • The management of significant events at the practice continued to be managed well and trends had been identified which showed positive outcomes regarding patients who were at the end of life.
  • Adult safeguarding policies had been improved immediately following the last inspection and were based on current practice guidelines set by the Wessex area team.
  • The procedure for the insertion of intrauterine coils had been amended to align with practice guidance set out by the Royal College of Obstetricians and Gynaecologists.
  • The infection and prevention and control processes and environmental health and safety risk assessments continued to be managed well.
  • Systems were in place to maintain and monitor equipment in the practice was well managed.
  • Arrangements were in place to monitor staffing numbers and skill mix and included the introduction of locality carers to provide care for end of life and vulnerable patients.
  • Effective arrangements were in place to manage emergencies and incidents.

Effective

Good

Updated 13 April 2017

The practice was rated as good for providing effective services at our inspection in September 2015. We did not inspect this domain on this visit.

Caring

Good

Updated 13 April 2017

The practice was rated as good for providing caring services at our inspection in September 2015. We did not inspect this domain on this visit.

Responsive

Good

Updated 13 April 2017

The practice was rated as good for providing responsive services at our inspection in September 2015. We did not inspect this domain on this visit.

Well-led

Good

Updated 13 April 2017

The practice was rated as good for providing well led services at our inspection in September 2015. We did not inspect this domain on this visit.

Checks on specific services

People with long term conditions

Good

Updated 13 April 2017

The provider had resolved the concerns for safety identified at our inspection on 17 September 2015 which applied to everyone using this practice, including this population group. The population group ratings have not been changed and remain good.

Families, children and young people

Good

Updated 13 April 2017

The provider had resolved the concerns for safety identified at our inspection on 17 September 2015 which applied to everyone using this practice, including this population group. The population group ratings have not been changed and remain good.

Older people

Good

Updated 13 April 2017

The provider had resolved the concerns for safety identified at our inspection on 17 September 2015 which applied to everyone using this practice, including this population group. The population group ratings have not been changed and remain good.

Working age people (including those recently retired and students)

Good

Updated 13 April 2017

The provider had resolved the concerns for safety identified at our inspection on 17 September 2015 which applied to everyone using this practice, including this population group. The population group ratings have not been changed and remain good.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 April 2017

The provider had resolved the concerns for safety identified at our inspection on 17 September 2015 which applied to everyone using this practice, including this population group. The population group ratings have not been changed and remain good.

People whose circumstances may make them vulnerable

Good

Updated 13 April 2017

The provider had resolved the concerns for safety identified at our inspection on 17 September 2015 which applied to everyone using this practice, including this population group. The population group ratings have not been changed and remain good.