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Inspection Summary


Overall summary & rating

Good

Updated 11 August 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Pirbright Surgery in Woking, Surrey on 6 October 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of safe services and good for the provision of effective, caring, responsive and well-led services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Pirbright Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 3 August 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 in October 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.

Our key findings were as follows:

  • The practice had reviewed existing arrangements regarding staff training, specifically safeguarding and infection control training. We saw all staff had completed training appropriate to their job role, for example the GPs all had completed Safeguarding Children level three training.

  • The practice had revised recruitment policies and processes which reflected national guidance. For example, supporting recruitment documentation which was missing during the October 2016 inspection had now all been recorded and documented correctly. Furthermore, the practice had reviewed and embedded a practice specific Disclosure and Baring Service (DBS) policy, which was supported by formal risk assessments.

  • The practice had established and was now operating safe systems to assess, manage and mitigate the associated risks relating to the management of medicines. This included implementation of a standardised fridge monitoring template which was now used within the practice and dispensary.

  • A formalised system had been implemented which ensured results were received for all samples sent for the cervical screening programme.

  • The practice had reviewed the range of emergency medicines held on site. We saw the practice now had appropriate arrangements in place to respond to emergencies and major incidents.

  • There was now an effective system in place for reporting and recording significant events. The practice had strengthened the existing significant event reporting procedure, which now included electronically recorded minutes and actions from the significant event meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 August 2017

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

Our last inspection in October 2016 identified concerns relating to how the practice managed and monitored risks, specifically risks associated with recruitment checks, training and medicines management.

We also saw concerns regarding how the practice recorded significant event analysis and the resulting action plans.

Furthermore, we noted that there was a limited range of emergency medicines on site; in particular there were no medicines to treat febrile convulsions or epileptic seizures.

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

  • The practice had established and was now operating safe systems to assess, manage and mitigate the risks identified relating to recruitment checks and training. For example, supporting recruitment documentation which was missing during the October 2016 inspection had now all been recorded and documented correctly. Furthermore, we saw all staff had completed training appropriate to their job role, for example the GPs all had completed Safeguarding Children level three training.

  • The management of medicines within the practice including the dispensary now reflected national guidance. For example, the practice had standardised protocols used to monitor fridge temperatures. We also saw the practice had embedded a new stock rotation protocol and provided staff awareness training which ensured medicines and vaccines were appropriately and safely stored in accordance with manufacturer’s instructions.

  • There was now an effective system in place for reporting and recording significant events. The practice had strengthened the existing significant event reporting procedure, which now included electronically recorded minutes and actions from the significant event meetings.

  • The practice had reviewed the range of emergency medicines held on site. We saw the practice now had appropriate arrangements in place to respond to emergencies and major incidents. For example, the practice had added medicines to the emergency medicines store to treat febrile convulsions and epileptic seizures.

Effective

Good

Updated 11 August 2017

Caring

Good

Updated 11 August 2017

Responsive

Good

Updated 11 August 2017

Well-led

Good

Updated 11 August 2017

Checks on specific services

People with long term conditions

Good

Updated 8 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.
  • Diabetes indictors were comparable to clinical commissioning group (CCG) and national averages. For example; 82% of patients with diabetes, on the register, last measured total cholesterol was five mmol/l or less compared to the CCG average of 80% and the national average of 80%.
  • Longer appointments and home visits were available when needed.
  • 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.

Families, children and young people

Good

Updated 8 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 most standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • 81% of eligible female patient’s notes recorded that a cervical screening test had been performed in the preceding five years which is comparable with the England average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice ran a weekly combined walk in baby clinic with the health visitors and there were doctors available for consultations, post-natal checks and 6-8 week developmental checks and a nurse available for immunisations.
  • We saw positive examples of joint working with midwives, health visitors and the local primary school.
  • The practice were working towards a Pace setter award for children and young people (Pace setter is an improvement programme for primary care).

Older people

Good

Updated 8 February 2017

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 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.
  • There are no nursing homes within the practice boundary but the practice were prepared to continue to provide services including visits to their patients who moved into local nursing homes outside of the practice catchment area.

Working age people (including those recently retired and students)

Good

Updated 8 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 proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 February 2017

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

  • 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
  • 94% of patients with severe and enduring mental health problems had a comprehensive care plan documented in their records within the last 12 months which was comparable to the CCG average of 92% and the national average of 89%.
  • 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 8 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promotes equality. This included people who are in vulnerable circumstances or who have complex needs.
  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • The practice offered flexible appointments to travellers and other vulnerable patients.
  • 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.