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Inspection Summary


Overall summary & rating

Good

Updated 4 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard Surgery on 29 September 2016. At this inspection the overall rating for the practice was good. The four domains of safe, responsive, caring and well led were rated as good. One domain, effective, was rated as requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Orchard Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 September 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 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good in all domains and good overall.

Our key findings were as follows:

  • Staff had received training appropriate to their role. The practice had improved training records and the oversight of training. All staff had completed fire safety awareness, infection control and information governance training. All staff had been provided with guidance to identify and locate adults at risk alerts on the practice computer system.
  • The practice had completed infection prevention control audits in order to continually assess cleanliness and address concerns. Blinds and carpets had been regularly cleaned. A cleaning schedule and regular management reviews ensured monitoring of cleaning was undertaken.
  • The practice had completed Disclosure and Barring Scheme (DBS) checks for all non-clinical staff who were trained as chaperones. All clinical staff had received a DBS check as standard practice.
  • The practice had introduced improvements in the recording of appraisals which enhanced the management of the process.
  • The practice ensured that all policies and procedures were dated at the time of writing and last review.
  • The practice had reviewed the locations of emergency equipment and medicines.
  • The practice had reviewed the appointment system with consideration of patient comments regarding not being given sufficient time to make decisions about their care and appointments not running on time. Extended time appointments were now offered by the practice and advertised to patients by staff and on displays in waiting areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 October 2017

At our previous inspection in September 2016, we rated the practice as good for providing safe services. However, we identified four areas within the safe domain where improvement should be made. These included:

  • Ensure that all staff were provided with guidance to identify and locate adults at risk alerts on the practice computer system.
  • Continue to make assessments of cleanliness and address concerns, including that blinds and carpets are regularly cleaned. Continue to record and monitor cleaning undertaken.
  • Consider completing a risk assessment or an enhanced Disclosure and Barring Scheme (DBS) check for all non-clinical staff who are trained as chaperones.
  • Review the locations of emergency equipment and medicines.

These arrangements had significantly improved when we undertook a follow up inspection on 12 September 2017.

At this inspection on 12 September 2017 we found that:

  • All staff had been provided with guidance to identify and locate adults at risk alerts on the practice computer system.
  • The practice had completed infection prevention control audits in order to continually assess cleanliness and address concerns. Blinds and carpets had been regularly cleaned. A cleaning schedule and regular management reviews ensured monitoring of cleaning was undertaken.
  • The practice had completed Disclosure and Barring Scheme (DBS) checks for all non-clinical staff who were trained as chaperones. All clinical staff had received a DBS check as standard practice.
  • The practice had reviewed the locations of emergency equipment and medicines.

Effective

Good

Updated 4 October 2017

At our previous inspection in September 2016, we rated the practice as requires improvement for providing effective services. We identified one area within the effective domain where improvement must be made:

  • Ensure all staff receive training appropriate to their role and continue to improve records and the oversight of training. Including that all staff complete fire safety awareness, infection control and information governance training.

We also identified one area where improvement should be made:

  • Consider improvements to the management of recording appraisals.

At this inspection in September 2017 we found the practice had made significant improvements in both of these areas.

  • Staff had received training appropriate to their role. The practice had improved training records and the oversight of training. All staff had completed fire safety awareness, infection control and information governance training.
  • The practice had introduced improvements in the recording of appraisals which enhanced the management of the process. These included a computerised spreadsheet which showed dates of last appraisal and future planned appraisal dates.

Caring

Good

Updated 4 October 2017

Responsive

Good

Updated 4 October 2017

At our previous inspection in September 2016, we rated the practice as good for providing responsive services. However, we identified one area within the responsive domain where improvement should be made:

  • Review the practice appointment system with consideration of patient comments regarding not being given sufficient time to make decisions about their care and feedback about appointments not running on time.

At this inspection in September 2017 we found the practice had made significant improvements in this area:

  • The practice had reviewed the appointment system with consideration of patient comments regarding not being given sufficient time to make decisions about their care and appointments not running on time. Extended time appointments were offered by the practice and advertised to patients by staff and on television displays in waiting areas.

Well-led

Good

Updated 4 October 2017

At our inspection in September 2016 we rated the well led domain as good. However, we identified one area within the responsive domain where improvement should be made:

  • Ensure all practice policies and procedures are dated at the time of writing and last review.

At this inspection in September 2017 we found the practice had made significant improvements in this area:

  • We saw evidence that the practice ensured that all policies and procedures were dated with the time of writing and last review. The practice used a computerised system to list all policies, date of first draft, update and review, future planned review. This was available to all staff.

Checks on specific services

People with long term conditions

Good

Updated 13 February 2017

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.

  • Performance for diabetes related indicators were in line with national averages. For example, the percentage of patients with diabetes whose blood glucose level was 64mmol/mol or less in the preceding 12 months was 81% compared with a national average of 78%.

  • Longer appointments and home visits were available when needed.
  • We saw examples of personalised care plans for patients with long term conditions.
  • 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.
  • The practice offered a range of services to people with long term conditions. This included clinics for diabetes with a specialist nurse, asthma and hypertension.

Families, children and young people

Good

Updated 13 February 2017

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, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 90%, which was comparable to the CCG average of 84% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 13 February 2017

The practice is rated as good for the care of older people.

  • All patients had a named GP, including those over 75.
  • 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.

Working age people (including those recently retired and students)

Good

Updated 13 February 2017

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 offered a full range of health promotion and screening that reflects the needs for this age group.
  • The practice was proactive in offering online services including booking/cancelling appointments and an electronic prescribing service.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 February 2017

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

  • Data from the Quality and Outcomes Framework (QOF) showed results were in line with national averages for this population group. For example the percentage of patients diagnosed with dementia whose care had been reviewed in the preceding 12 months was 89% which was comparable to the CCG average of 86% and the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • 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 13 February 2017

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 in normal working hours and out of hours.