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Inspection Summary


Overall summary & rating

Good

Updated 21 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lambourn Surgery on 7 October 2016. The overall rating for the practice was good. However, the practice was found to require improvement in the provision of safe services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Lambourn Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 7 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Provision of safe services is now rated good and overall the practice remains rated as good.

Our key findings were as follows:

  • Medicines fridges were kept in a secure location within the practice.
  • Vaccines stored within medicines refrigerators were kept in accordance with best practice guidance.
  • Treatment room flooring was fitted in line with best practice for reducing the risk of cross infection.
  • Appropriate systems were in place for the safe disposal of sharps bins.
  • Staff training was up to date and relevant to the roles of staff.
  • Competency checks had been completed and recorded for dispensary staff.
  • An appropriate system was in place to report dispensing incidents, including near misses. Learning from dispensary incidents was shared and staff were aware of the learning.

We found aspects of the service where the provider should make improvement:

  • A review of the risk assessment for keeping liquid nitrogen on site should be completed in sufficient detail to identify all storage risks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 June 2017

The practice had taken appropriate action and is now rated as good for the provision of safe services.

  • The area where medicines fridges were located was kept secure.
  • Vaccines were kept in medicines fridges in accordance with best practice guidance.
  • Appropriate systems were in place for the disposal of sharps bins and treatment rooms were fitted with appropriate floor coverings.
  • Training in delivery of safe services had been completed. For example, safeguarding and basic life support.
  • Appropriate arrangements were in place for the reporting, recording and learning from events that occurred in the dispensary.
  • The risk assessment for keeping liquid nitrogen on site had not been reviewed in detail to assess associated with the room in which it was stored.

Effective

Good

Updated 22 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were variable compared to CCG and national averages. The most recent published results from 2014 to 2015 were 89% of the total number of points available compared to the CCG average of 95% and national average of 95%. The practice showed us QOF data for 2016 and this showed that the practice had achieved higher results with 91% of the total number of points available.

  • Performance for diabetes related indicators was lower than the CCG and national averages for some indicators and similar for others. The practice had employed a number of measures to improve the care received by patients with diabetes. The practice nurse told us that these measures had since resulted in a 25% reduction in patients with poorly controlled diabetes.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement. For example, the practice had implemented measures to audit and improve bowel screening rates and also the rates of thyroid function tests for patients taking a particular medicine.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. However, not all staff had received training updates in a timely fashion.

  • 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 22 November 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.

  • The practice’s computer system alerted GPs if a patient was a carer and staff directed carers’ to support services.

  • GPs were proactive in providing emotional support for patients nearing their end of life and their family members. We saw evidence that this was positively received by patients.

Responsive

Good

Updated 22 November 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of the local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. One member of staff was undertaking further training to increase their knowledge of clinical issues in order to undertake an extended role. The practice had also liaised with the CCG to arrange transport for patients in the practice catchment area.
  • Patients said they found it easy to make an appointment with a 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 of varied ages and meet their needs.
  • The practice had taken steps to ensure that appointments were accessible to patients with difficulties with mobility, hearing, eyesight, memory, and communication.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 22 November 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.

  • 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.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 22 November 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.

  • Performance for diabetes related indicators was lower than the CCG and national averages for some indicators and similar for others. They had employed a number of measures to improve the care received by patients with diabetes. The practice nurse told us that these measures had since resulted in a 25% reduction in patients with poorly controlled diabetes.

  • Longer appointments and home visits were available for patients with long term conditions when needed.

  • Patients with long term conditions had 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.

Families, children and young people

Good

Updated 22 November 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 patients who had a high number of A&E attendances.
  • Childhood immunisation rates were in line with CCG and national averages.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 81%, which was lower than the CCG average of 88% and similar to the national average of 82%.
  • Appointments were available outside of school hours and the practice had taken steps to ensure that a greater number of same day appointments were available outside of school hours to meet patient need.
  • Premises were suitable for children and babies. There were toys in the waiting area, baby changing facilities, and nappies available.
  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 22 November 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 patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice provided visits to patients living in residential homes.

  • The practice website and waiting area contained information about health conditions and support services relevant to older patients.

  • The practice had liaised with the CCG to ensure that patient transport services were available for patients in the practice catchment area.

  • The practice encouraged patients to register as carers. They provided information for carers in the waiting area and on the website and had invited a representative from a local carers’ group to spend the morning at the surgery to provide information to patients.

Working age people (including those recently retired and students)

Good

Updated 22 November 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.
  • Early morning and some evening and weekend appointments were available.
  • The practice had reviewed appointment need and as a consequence offered additional same day appointments during the early afternoons to meet the needs of the local racing community.
  • The GPs provided visits to patients at a local rehabilitation centre for people with complex physical needs.
  • The practice provided meningitis immunisations for university students.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 November 2016

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

  • The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 94% which was high compared to the CCG average of 85% and national average of 84%.

  • The practice had completed a dementia audit tool and taken steps to make the environment more suitable for people with dementia.

  • The practice had signed up the Dementia Friends scheme and staff had received training on how to support patients with dementia.

  • The percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 96% compared to the CCG average of 90% and national average of 90%.

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

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 22 November 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, travellers 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.