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Inspection Summary


Overall summary & rating

Good

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Milton Surgery on 27 April 2016. At this time we noted that systems and processes were not established and operated effectively to ensure that clinicians were overseeing and checking changes to patients’ prescriptions. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to ensuring effective processes were in place.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link for on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 January 2017

At the last inspection on 27 April 2016 we found that:

  • Patients were not fully protected against the risks associated with the management of medicines because there were not appropriate arrangements in place for the safe dispensing of medicines. Prescriptions were reviewed and signed by GPs before they were given to the patient. However, following discharge from hospital, dispensers made changes to patients’ medicines which were not satisfactorily checked by GPs to ensure safety.

Our focused inspection on 3 January 2017 found that:

  • The practice had implemented a clear policy and audit system to ensure that medication changes made as a result of correspondence from secondary care providers were accurate and had been authorised by a GP.

This report should be read in conjunction with the full inspection report from 27 April 2016.

Effective

Good

Updated 13 June 2016

  • 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.
  • There were joint working relationships with community services and engagement with health and social care providers to co-ordinate care and meet patients’ needs.

Caring

Good

Updated 13 June 2016

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care. For example 95% said the last GP they saw was good at listening to them.
  • Patients said they were treated in a respectful and empathetic way by the practice’s staff.
  • Staff understood the importance of confidentiality and patient information was managed well.
  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 13 June 2016

  • The practice offered a range of services and was well equipped to treat patients and meet their needs.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • 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 the patient participation group.

Well-led

Good

Updated 13 June 2016

  • Staff were supported and well managed at all times, and there were clear lines of responsibility and accountability within the practice .
  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • Staff had received inductions, regular performance reviews and attended staff meetings and events.
  • 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.
  • The practice sought feedback from staff and patients, which it acted on. The patient participation group was active and met regularly making suggestions for improvements.
Checks on specific services

People with long term conditions

Good

Updated 13 June 2016

The practice is rated as good for the care of people with long-term conditions. There was an effective patient recall system in place to ensure that patients’ health needs were reviewed. Longer appointments and home visits were available when needed and patients at risk of hospital admission were identified as a priority. GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care to patients with the most complex needs.

Families, children and young people

Good

Updated 13 June 2016

The practice is rated as good for the care of families, children and young people. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice worked with local health visitors, midwives and school nurses to offer a full health surveillance programme for children. Immunisation rates were relatively high for all standard childhood immunisations. The practice’s web site contained links to support groups and advice specifically for young people.

Older people

Good

Updated 13 June 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example in end of life care.

The practice was part of a pilot scheme with Cam Health and the Alzheimer’s Society and had a specialist nurse attached to the practice to support to patients there. It worked closely with the Parish village warden to support older patients in the community. The practice’s PPG held a local drop in café where they encouraged older patients to attend for friendship, advice and support.

Working age people (including those recently retired and students)

Good

Updated 13 June 2016

The practice is rated as good for the care of working age people (including those recently retired and students). The needs of these patients been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Appointments were available with the GPs and nurses from 8am each morning. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group and uptake was high compared to local and national averages.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice performed well in indicators for depression, dementia and mental health. Patients with significant mental health problems had annual mental health and medicines reviews. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

People whose circumstances may make them vulnerable

Good

Updated 13 June 2016

The practice is rated as good for the care of people whose circumstances might make them vulnerable. 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. The practice regularly worked with other health care professionals in the case management of vulnerable patients

The uptake of health check for patients with a learning disability was high and specific information packs were available to support carers.