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Archived: Townhill Medical Practice Good

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Inspection Summary


Overall summary & rating

Good

Updated 27 June 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Townhill Medical Practice in Caterham, Surrey on 24 August 2016 we found two breaches of regulation relating to the provision of safe and effective services. The overall rating for the practice was requires improvement. The concerns which led to these ratings applied to everyone using the practice and we rated all population groups as requires improvement. Specifically, the practice was rated requires improvement for the provision of safe and effective services. The practice was rated good for the provision of caring, responsive and well-led services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Townhill Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 June 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 in August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

  • The practice was now ensuring all patient records were securely held. Electronic access to patient records was now available for all practice clinicians to use in the school and at the nursing homes which the practice provides GP services for.

  • Training arrangements were consistent; there was now a system to identify when staff had training and when it would need to be refreshed. All staff had completed training appropriate to their job role. For example, all GPs had completed the correct level of safeguarding training appropriate to their job role.

  • The practice was now operating safe systems in relation to health and safety. The practice had established and was now operating an effective system to assess, manage and mitigate the risks identified relating to the storage of liquid nitrogen.

  • The practice had revised recruitment policies and processes which reflected national guidance. For example, supporting recruitment documentation which was missing during the August 2016 inspection had now all been recorded and documented correctly including evidence of full employment history for members of staff.

  • Blank prescription forms and pads were kept securely and tracked through the practice.
  • The practice had reviewed and updated the practice governance framework. This included a review of health and safety arrangements and supporting policies and procedures.
  • Following the August 2016 inspection, the practice immediately developed and implemented a system for recording when Deprivation of Liberty Safeguards were in place. The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005. The Mental Capacity Act allows restraint and restrictions to be used – but only if they are in a person's best interests.
  • Further steps had been taken to monitor patient satisfaction including a survey completed in February 2017. This survey involved the patient participation group (PPG) and specifically reviewed patient satisfaction regarding telephone access to the practice.
  • Following a review of the management of diabetes within the practice population, improvements had been made including completed diabetic audits and the appointment of a special diabetes nurse. These actions had strengthened how the practice managed diabetes ensuring these patients received appropriate care and treatment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 June 2017

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

Our last inspection in August 2016 identified concerns relating to how the practice managed and monitored risks. We saw most risks to patients were assessed and managed, with the exception of recruitment checks, the storage, transport and use of liquid nitrogen and the security of medical records for patients accessing GP services in residential facilities.

We also noted blank prescription forms used within the practice were not tracked in accordance with national guidance.

Using information provided by the practice we found the concerns had been addressed:

  • The practice had revised the practice policy for recruitment. We saw this now ensured all recruitment records including employment history were documented and recorded.

  • We saw the practice was operating safe systems in relation to health and safety. The practice had established and was now operating an effective system to assess, manage and mitigate the risks identified relating to the storage of liquid nitrogen.

  • The practice was ensuring all patient records were securely held. Electronic access to patient records was now available for all practice clinicians to use in the school and at the nursing homes which the practice provides GP services for.
  • The practice had introduced a system for tracking and monitoring the use of blank prescription forms and pads. This system was now in line with national guidance.

Effective

Good

Updated 27 June 2017

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

Our last inspection in August 2016 identified concerns relating to how staff received appropriate training and professional development. The practice could not demonstrate that staff had all the skills, knowledge and experience to deliver effective care and treatment. For example, we noted that not all staff had received training that included safeguarding, fire safety awareness, basic life support and information governance.

We also noted although clinical staff demonstrated understanding of consent, they had not received training that included the requirements of the Mental Capacity Act 2005.

Using information provided by the practice we found the concerns had been addressed:

  • Training arrangements were consistently managed. These arrangements and staff files including certificates indicated all staff had completed training relevant to their role including safeguarding, fire safety awareness, basic life support and information governance.
  • The practice has also engaged closely with the training provider to ensure the practice was supporting staff to acquire new skills and share best practice. This included training on the Mental Capacity Act 2005.

Caring

Good

Updated 11 January 2017

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 11 January 2017

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 Clinical Commissioning Group to secure improvements to services where these were identified. For example the practice hosts a wellbeing counselling service.
  • 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 acted on feedback from patients regarding difficulties getting through to the surgery on the phone. They had installed a new telephone system and increased the number of staff available to answer the phone when call volumes are high.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a robust system in place for prioritising home visits with a single member of staff each shift taking responsibility for the visit and urgent appointment requests.
  • 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.

Well-led

Good

Updated 11 January 2017

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, but some of these were missing or overdue a review, 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. 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 27 June 2017

The provider had resolved the concerns for safety and effectiveness identified at our inspection on 24 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • Performance for diabetes related indicators was comparable to the clinical commissioning group (CCG) and national averages. Previous concerns (reporting for 2014/15) regarding significantly high levels of exception reporting had been addressed and improved. The practice provided us with information and data for 2015/16 which showed improvement, a reduction from 21% to 17%. Exception reporting is the removal of patients from Quality and Outcomes Framework (QOF) calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.

Families, children and young people

Good

Updated 27 June 2017

The provider had resolved the concerns for safety and effectiveness identified at our inspection on 24 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Older people

Good

Updated 27 June 2017

The provider had resolved the concerns for safety and effectiveness identified at our inspection on 24 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • The practice was now ensuring all patient records were securely held. Electronic access to patient records was now available for all practice clinicians to use in the nursing homes which the practice provides GP services for. We saw this provided direct, immediate access to the patient’s records, keeping them maintained and up to date electronically, thus providing a complete, contemporaneous record.

Working age people (including those recently retired and students)

Good

Updated 27 June 2017

The provider had resolved the concerns for safety and effectiveness identified at our inspection on 24 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 June 2017

The provider had resolved the concerns for safety and effectiveness identified at our inspection on 24 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People whose circumstances may make them vulnerable

Good

Updated 27 June 2017

The provider had resolved the concerns for safety and effectiveness identified at our inspection on 24 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • Following the August 2016 inspection, the practice immediately developed and implemented a system for recording when Deprivation of Liberty Safeguards were in place. The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005. The Mental Capacity Act allows restraint and restrictions to be used – but only if they are in a person's best interests.