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Archived: Drs K Conod & S Garsed Good Also known as The Limes Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 7 October 2014. We found the practice was in breach of legal requirements. The breaches related to regulation 9 (Care and welfare) and 13 (Management of medicines) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponded to regulation 12 (Safe care and treatment) and regulation 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We undertook this focused inspection on 30 September 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drs K Conod, S Caddy & S Garsed on our website at www.cqc.org.uk

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns such as safeguarding, and to report incidents, including significant events.
  • Systems were in place to ensure the safe storage of vaccinations and patient samples.
  • Infection control procedures were in place but systems to monitor and maintain standards should be improved.
  • Emergency medicines and medical equipment were managed safely and staff were aware of their roles in the event of a medical emergency.
  • Non clinical staff did not have a disclosure and barring service (DBS) check or risk assessment in place to determine if a DBS check was required.
  • There were plans in place to ensure the practice could still operate in the event of a major incident and staff we spoke with were aware of the plans.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

  • Risk assess staff who do not have a disclosure and barring service (DBS) check in place.
  • Develop robust system to monitor and maintain standards of cleanliness within the general environment and ensure all actions from the recent infection control audit are completed including infection control training for all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 December 2015

The practice is rated as good for providing safe services. There were arrangements in place to share significant events and incidents with staff to ensure learning and reflection. Staff were aware of their role and responsibilities in relation to safeguarding children and vulnerable adults.

Systems were in place to ensure the safe storage of vaccinations and patient samples. There was evidence to demonstrate that checks had been undertaken on emergency medical equipment. Staff had received training in responding to a medical emergency and were aware of their roles. Fire extinguishers had been checked to ensure they were in good working order.

There were plans in place to ensure the practice could still operate in the event of a major incident and staff we spoke with were aware of the plans.

Infection control procedures were in place however, some areas of the environment were not visibly clean and needed further attention.

Non clinical staff did not have a disclosure and barring service (DBS) check or risk assessment in place to determine if a DBS check was required.

Effective

Good

Updated 10 December 2015

Caring

Good

Updated 10 December 2015

Responsive

Good

Updated 10 December 2015

Well-led

Good

Updated 10 December 2015

Checks on specific services

People with long term conditions

Good

Updated 14 May 2015

The practice is rated as good for the care of people with long-term conditions. The practice had arrangements to care for people with long term health conditions, for example those with chronic obstructive pulmonary disease (COPD) and diabetes. There was a clinical lead to ensure patients were called for check-ups for conditions such as diabetes. The practice was undertaking an enhanced service to reduce unnecessary emergency admissions to hospital. The focus of this enhanced service was to target specific patient groups such as patients with long term conditions and develop plans for coordinated care. Patients who were on long term medication, as a result of their condition, received regular reviews to assess their progress and ensure their medications remained relevant to their health needs. Regular review meetings were held with a multidisciplinary team to discuss each patient. There were arrangements to share information with out of hours services when the practice was closed to ensure people received co-ordinated care and treatment which met their needs.

Families, children and young people

Good

Updated 14 May 2015

The practice is rated as good for the care of families, children and young people. The practice had arrangements in place to ensure the needs of mothers, babies, children and young people were met. For example the practice nurse undertook childhood vaccination programmes, and chlamydia testing. Antenatal care was provided by both midwife and the GPs on a shared-care basis and postnatal examinations are done by the GP. The practice had stopped running baby clinics at set times because working patients could not always attend the clinic times. As a result parents were able to book appointments for a check-up of their babies at a time that suited them. Health Visitors were available for general advice on sleeping and feeding in respect of new born babies. Young adults had access to preventative sexual health services provided by the practice including screening for Chlamydia (a sexually transmitted disease).

Older people

Good

Updated 14 May 2015

The practice is rated as good for the care of older people. The practice was accessible for patients who had limited mobility.. All the consultation rooms were on the ground floor of the practice. If patients were unable to attend the practice because they were housebound they could be seen at home. Telephone consultations were also available. We received good feedback from managers of local care home regarding the service offered by the practice. They told us that the GPs undertook home visits on request. Health checks and medication reviews took place and repeat prescriptions were easily accessible. The practice was taking part in the enhanced service aimed at reducing avoidable unplanned emergency admissions to hospitals for vulnerable and older people. There were arrangements in place to ensure continuity of care for those patients who needed end-of-life care.

Working age people (including those recently retired and students)

Good

Updated 14 May 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice had appropriate arrangements in place to ensure the needs of working age patients and those recently retired were met. Access to the service could be made by telephone, in person or online; via the internet. Consultations with a GP were available from 8:30am Monday to Friday and patients were able to see a nurse from Monday to Friday 7:30am to 11:30am. There was a recall system in place for cervical screening. This procedure was carried out by the practice nurse. Information leaflets and posters were available in the patient waiting area and on the practice website to support and signpost people to support groups and organisations. This included information about self-management of minor illnesses. Opportunistic health checks and advice was offered (for example blood pressure checks and advice on family planning). Holiday vaccination advice was available through consultation with a practice nurse.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Dementia screening for all patients over 65 was available at the practice. This enabled patients to receive appropriate treatment and support if they were developing symptoms of dementia. The practice offered depot injections. These are longer acting injected medicines used for some patients experiencing mental ill health. Patients with mental health problems had the choice of having this injection at their GP surgery rather than an outpatient clinic or mental health centre if this was more convenient or more preferable to them. A community psychiatric nurse (CPN) was based at the practice two afternoons a week. There was a three week waiting time to see the CPN who was funded by the Clinical Commissioning Group (CCG).

People whose circumstances may make them vulnerable

Good

Updated 14 May 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. People were able to telephone the practice and speak with a doctor for a telephone consultation. This allowed timely access to vulnerable patients and supported decisions relating to hospital admissions, in order to reduce avoidable hospital admissions or A&E attendances. The practice had identified vulnerable people and completed care plans to help ensure they received the most appropriate care. The practice carried pout regular NHS Health Checks as well as alcohol screening which helped patients to receive the appropriate advice, support and treatment. Information leaflets and posters were available in the patient in the practice and on the practice website to support and signpost people to support groups and organisations. The practice offered sexual health and substance misuse support, advice, and referral for patients. Staff members we spoke with were unsure what they would do if a patient without a fixed address needed to see a GP. The practice did not have a clear policy in place if such a situation was to occur.