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Dorking Medical Practice Good

Reports


Inspection carried out on 10 July to 11 July 2019

During a routine inspection

We carried out an announced comprehensive inspection at Dorking Medical Practice on 10 and 11 July 2019 as part of our inspection programme.

We had previously carried out an announced comprehensive inspection at Dorking Medical Practice in March 2015 and a follow up inspection in March 2016. The practice was last rated as Good overall and Good in all domains. All of the practices previous reports can be found by selecting the ‘all reports’ link for Dorking Medical Practice on our website www.cqc.org.uk

We carried out an inspection of this service due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions:

  • Is it Safe
  • Is it Effective
  • Is it Caring
  • Is it Responsive
  • Is it Well led

We have rated this practice as good overall and in all of the key questions. They have been rated as good overall for all population groups.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We rated the practice good for providing safe, effective, caring, responsive and well-led care because:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs.
  • Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • There was a clear leadership structure and staff felt supported by management.
  • Staff worked well together as a team and all felt supported to carry out their roles. There was a strong team ethos and culture of working together for a common aim.

Whilst we found no breaches of regulations, the provider should:

  • Continue to review and improve ways to increase uptake for cervical screening
  • Continue to implement changes required due to the merger and adopt where possible a single method
  • Review the location of the emergency drugs at New House Surgery to ensure they would be readily available

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 03 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 16 June 2015. Breaches of legal requirements were found during that inspection within the safe domain. Concerns were identified at the main practice and at the branch surgery Hillside Surgery. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following, that the provider must:

  • Ensure that medicines are stored safely so as not to allow unauthorised access and that all medicines are reviewed for expiry dates.

  • Ensure that the appropriate action has been recorded where fridge temperatures are above the recommended temperature range .

  • Ensure that handwritten prescriptions tracked through the practice at all times.

  • Ensure that the cold chain for medicines has been validated

  • Monitor cleaning standards throughout the practice and ensure that the infection control audit accurately reflects the standard of cleaning and cleaning records.

We undertook this announced focused inspection on 3 March 2016. We visited the main surgery and at the branch surgery to check that the provider had followed their action plan and that the actions taken by the provider had met legal requirements. At this inspection we found that the provider was now meeting all requirements and was rated by us as good under the safe domain. 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 on our website at www.cqc.org.uk

Our key findings across the areas we inspected on 03 March 2016 were as follows:-

  • Medicines storage did not allow unauthorised access and since our comprehensive inspection a new policy had been put in place for the reviewing of expiry dates. At this inspection, the medicines we reviewed were all in date.

  • Staff had been re-informed of the appropriate action to take if fridge temperatures were above or below the recommended temperature range. Staff we spoke with were able to tell us the action to be taken. Fridge temperatures were recorded on a daily basis and none of these had been above or below the recommended range since the last inspection.

  • Blank prescriptions were now tracked through the practice at all times and this was recorded centrally on the practice computer system.

  • Medicines transported from the main surgery to the branch surgery were suitable transferred and the cold chain validated.

  • Cleaning standards throughout the practice were routinely monitored and infection control audits accurately reflected the standard of cleaning.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 16 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

The practice has an overall rating of good.

We carried out an announced comprehensive inspection at Dorking Medical Practice on 16 June 2015. Dorking Medical Practice provides personal medical services to people living in the Dorking area. At the time of our inspection there were just under 9,600 patients registered at the practice with a team of four partner GPs, four salaried GPs, practice nurses, healthcare assistants, a team of receptionists and administration staff, a dispensing team and a practice manager. The practice has a smaller dispensing branch surgery (Hillside Surgery) which we did not inspect, however we did review the dispensary service at this location.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It requires improvement for providing safe services, specifically in relation to medicines management and cleanliness and hygiene. We found the practice was delivering a good service to all its population groups.

At the time of the inspection only two of the partner GPs were registered with CQC. We spoke with the practice manager in relation to this, who informed us they were in the process of submitting the required forms to CQC. We saw evidence that confirmed this was the case.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients spoke positively about how they were treated by staff and we noted that this was consistent with comment cards and patient survey feedback.
  • Information about services and how to complain was available and easy to understand.
  • Most patients said they found it easy to make an appointment with the GP and that urgent appointments were available the same day.
  • The practice was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management.
  • The practice proactively sought feedback from staff and patients, which it acted on.

  • The practice issued “calendar packs” rather than “blister packs” for high risk patients or high risk medicines, to assist patients in taking the correct dosage on the correct day.
  • The practice had a repeat prescribing system which allowed repeat prescriptions which had previously been authorised for three or six cycles to be re-authorised by practice staff.
  • The practice had created a consistent approach to the repeat prescribing system

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

The Provider must;

  • Ensure that medicines are stored safely so as not to allow unauthorised access and that all medicines are reviewed for expiry dates.
  • Ensure that the appropriate action taken has been recorded where fridge temperatures are above the recommended temperature range
  • Ensure that handwritten prescriptions are tracked through the practice at all times.
  • Ensure that the cold chain for medicines has been validated
  • Monitor cleaning standards throughout the practice and ensure the infection control audit accurately reflects the standard of cleaning and cleaning records.

In addition the provider should:

  • Include advocacy and ombudsman details in information given to patients about how to make a complaint.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice