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Observatory Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 18 April 2017

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Observatory Medical Practice on 16 August 2016 found breaches of regulations relating to the safe care and treatment. The overall rating for the practice was good. However, they were rated requires improvement in the safe domain. The full comprehensive report from the August 2016 inspection can be found by selecting the ‘all reports’ link for Observatory Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused desktop inspection (we have not visited the practice but requested information to be sent to us) carried out on in March 2017. It was conducted 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. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. The information requested in March 2017 identified that the practice was meeting the regulation 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. In addition the practice made improvements to its services where we suggested this could improve services for patients.

Our key findings were as follows:

  • Improvements had been made in the storage of medicines and procedures for when vaccines were potentially compromised.
  • Liquid nitrogen storage had been reviewed and improvements made.
  • Child immunisations had been reviewed, training provided to staff and a review of children who had not attended undertaken.
  • A change to medicine review processes had been implemented to improve uptake within required timescales.
  • The practice undertook its own survey to identify whether patient feedback was accurately portrayed in the national survey and this found positive feedback on the areas which had been of concern.

In addition to the areas where we told the provider they must make improvements, there were also actions where we suggested the provider should make improvements. In response they undertook the following actions.

  • A review of child immunisations had been undertaken and action to improve uptake.
  • The process for medicine reviews had been changed to increase uptake for timely reviews.
  • The practice undertook their own survey in October 2016 to focus on areas where the national survey had identified less positive feedback from patients when compared to local and national averages. The practice’s own survey of 453 patients showed patient feedback was significantly better in the practices own survey in these specific areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 April 2017

When we inspected the practice in August 2016 we found risks to patients were mainly assessed and well managed. However, there were issues identified in the monitoring of a fridge used for storing medicines and risks related to liquid nitrogen were not always managed.

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

  • A medicine potentially required for the treatment of hypoglycaemia had been reviewed and followed national guidance.
  • We reviewed an updated risk assessment on the storage of liquid nitrogen. The storage of the substance had been reviewed and changes made to ensure it was well ventilated in the event of a leak.
  • An amended cold chain policy had been implemented since our previous inspection in August 2016 and the system for monitoring fridges had improved.

Effective

Good

Updated 18 April 2017

Caring

Good

Updated 18 April 2017

Responsive

Good

Updated 18 April 2017

Well-led

Good

Updated 18 April 2017

Checks on specific services

People with long term conditions

Good

Updated 14 September 2016

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.
  • The most recent published results showed 99% of the total number of points available compared to the clinical commissioning group (CCG) average of 97% and national average of 95%. The extent of patients excepted from long term condition reviews was reduced in 2016 compared to 2015.
  • There were nurse home visits offered for patients with long term conditions who found it difficult to make it to the practice.
  • All these patients were offered 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 14 September 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 similar to average 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.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Joint working with external organisations took place in the management of children at risk of abuse.

Older people

Good

Updated 14 September 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.
  • GPs offered home visits and urgent appointments for those with enhanced needs.
  • The premises were accessible for patients with limited mobility and there was a hearing aid loop available for patients with poor hearing.
  • Patients over 75 had a named GP.
  • There were nurse home visits offered for patients with long term conditions who found it difficult to make it to the practice.

Working age people (including those recently retired and students)

Good

Updated 14 September 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.
  • Patients’ feedback on the appointment system was very positive overall.
  • The appointment system was monitored to identify improvements where possible.
  • 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.
  • Travel vaccinations were available.
  • There were extended hours appointments available.
  • The practice registered patients from two Oxford University colleges and a designated GP was assigned to ensure there was monitoring of this group of patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 September 2016

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

  • Performance for mental health related indicators was 91% compared to the national average 92% and regional average of 95%.Exception reporting for mental health indicators was slightly below the national average (11%) and regional average (11%) at 9%.
  • The proportion of patients on the mental health conditions register with a care plan was 84% compared to the local 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 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.

People whose circumstances may make them vulnerable

Good

Updated 14 September 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 homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for vulnerable patients including those 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.
  • Joint working with external organisations took place in the management of patients at risk of abuse or harm.
  • The staff worked closely with substance and alcohol misuse service providers in supporting these patients.