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Dr A S Whitaker & Partners Good Also known as Bridge Street Surgery

Inspection Summary


Overall summary & rating

Good

Updated 25 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 31 March 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to

1. Regulation 17 HSCA (RA) Regulations 2014 Good governance.

How the regulation was not being met:

The provider did not have suitable arrangements in place to ensure staff followed policies and procedures about managing medicines.

The provider did not have suitable arrangements in place to consult national recognised guidance about delivering safe care and treatment and implement this as appropriate.

2. Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed.

How the regulation was not being met:

The provider had not ensured that the information specified in Schedule 3 was available for each person employed. In addition, they had not established effective recruitment and selection procedures.

We undertook this focused inspection on 23 November 2016 to check that they had followed their plan and to confirm that they now met 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 Dr AS Whitaker & Partners on our website at www.cqc.org.uk

From the inspection on 31 March 2016, the practice were told they must:

• Ensure the storage of controlled drugs are managed in accordance with the relevant legislation.

• Put in place a procedure to manage national medicines safety alerts.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure appraisals are documented.

We found that on 23 November 2016 the practice now had improved systems in place.

  • The practice had ceased to store controlled drugs.
  • We saw that a procedure had been put in place to manage national medicines safety alerts.
  • Records we looked at confirmed that staff recruitment checks had been completed.
  • We saw evidence that appraisals were documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 January 2017

The practice is rated as good for providing safe services.

There had been concerns at the previous inspection about the way that medicines were managed.  At this inspection we saw that improvements had been made to address the issues.

We also checked and found that the practice now had a system in place to ensure that all the necessary employment recruitment checks were undertaken.

Effective

Good

Updated 25 January 2017

The practice is rated as good for providing effective services.

There had been concerns at the previous inspection about the lack of documentation regarding staff appraisals. At his inspection we found there was evidence of staff appraisal.

Caring

Good

Updated 25 May 2016

The practice is rated as good for providing caring services.

  • Data showed that 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 that staff treated patients with kindness and respect. Discussions at the reception desk can be overheard by others in the waiting area however confidentiality was maintained.

Responsive

Good

Updated 25 May 2016

The practice is rated as good for providing responsive services.

  • The practice 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff.
  • Patients said they found it easy to make an appointment although not always with their choice of GP. There were urgent appointments available the same day.
  • People could access appointments and services in a way and at a time that suited them. Repeat prescriptions could be ordered and appointments booked online. Telephone appointments were available and there was extended opening hours on Monday and Tuesday.
  • The branch surgery was open Tuesday 9am -11am and Thursday 11.30am – 2pm.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.

Well-led

Good

Updated 25 May 2016

The practice is rated as good for being well-led.

  • It 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 this.
  • There was a clear leadership structure and staff felt supported by management. .
  • The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice had a number of policies and procedures to govern activity, but some of these were overdue a review.
Checks on specific services

People with long term conditions

Good

Updated 25 May 2016

The practice is rated as good for the care of people with long-term conditions.

  • All patients with complex needs had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 25 May 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 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 25 May 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 people in its population.
  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Longer appointments were available for older people when needed, and this was acknowledged positively in feedback from patients.

Working age people (including those recently retired and students)

Good

Updated 25 May 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 reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 May 2016

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

  • Nationally reported data from 2014/2015 showed 71% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average 75% and the national average 77%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advanced 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.
  • It 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 25 May 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 those with a learning disability.
  • Longer appointments were offered for people with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Vulnerable patients had been told 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.