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The Doctors House - Marlow Medical Group Good

Inspection Summary


Overall summary & rating

Good

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

In April 2015 we found concerns related to the management of medicines during a comprehensive inspection of The Doctors House - Marlow Medical Group. Following the inspection the provider sent us an action plan detailing how they would improve medicine management systems ensuring they reflect national guidelines.

We carried out a desktop review of The Doctors House - Marlow Medical Group on 17 December 2015 to ensure these changes had been implemented and that the service was meeting regulations. Our previous inspection in April 2015 had found a breach of regulations relating to the safe delivery of services. The ratings for the practice have been updated to reflect our findings.

We found the practice had made improvements since our last inspection on 15 April 2015 and they were meeting the regulation relating to the management of medicines that had previously been breached.

Specifically the practice was operating safe systems in relation to the management of medicines. This included:

  • Disseminating medicine alerts within the practice.

  • Ensuring the temperatures in the practice refrigerators including dispensary were accurately recorded.

  • Formal arrangements were in place and staff were aware how these operate to ensure the security of prescriptions in accordance with national guidance.

  • A review and subsequent structure change of the management of dispensary at the Lane End branch surgery.

We have changed 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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 January 2016

The provider was providing safe services.

Since our last inspection in April 2015 systems had been put in place and embedded to ensure the management of medicines reflected national guidelines.

  • Medicine alerts were disseminated within the practice ensuring any changes to protocols were actioned.

  • Blank prescription forms were handled in accordance with national guidance and kept securely at all times.

  • Refrigerator temperatures were accurately recorded; this included current temperature and minimum and maximum temperatures. The dispensary fridge was equipped with an alarm that sounded if the temperature deviates from the required range.

  • We saw evidence that the dispensing staff had completed appropriate qualification for this role and following a management structure review we saw regular supervision and continued professional development for this member of staff.

Effective

Good

Updated 21 January 2016

Caring

Good

Updated 21 January 2016

Responsive

Good

Updated 21 January 2016

Well-led

Good

Updated 21 January 2016

Checks on specific services

People with long term conditions

Good

Updated 9 July 2015

The practice is rated as good for the care of patients with long-term conditions. GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice had registers for patients needing diabetic care and asthma. This helped to ensure each patient’s condition was monitored and that their care was regularly reviewed. For example, 895 out of 1061 patients with diabetes had received an annual review of their condition in the period of 1st April 2014 and 31st March 2015. In the same period, 957 out of 1598 patients with asthma had received review of their health. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication 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. 

Families, children and young people

Good

Updated 9 July 2015

The practice is rated as good for the care of families, children and young patients. Immunisation rates were high for all standard childhood immunisations. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. The practice target group of women who were due smears in the last five years was 5998, out of which 5445 patients had received cervical screen in the last five years.

Older people

Good

Updated 9 July 2015

The practice is rated as good for the care of older patients. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits. The practice had a total of 2650 patients registered who were 75 and over and 2102 of these patients had received seasonal influenza vaccination in the period of September 2014 and March 2015.

Working age people (including those recently retired and students)

Good

Updated 9 July 2015

The practice is rated as good for the care of working-age patients (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. The practice had high proportion of working age population. The practice had 18409 patients who were aged between 19-74 years of age, out of which 5112 had received travel advice.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 July 2015

The practice is rated as good for the care of patients experiencing poor mental health (including people with dementia). The practice kept a mental health register. 105 out of 174 patients had a current care plan either from the mental health team or a care plan agreed with their named GP. These patients were also signposted to local counselling services, such as healthy minds, for further advice and support. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice had diagnosed 102 patients with depression between the period of April 2014 to March 2015, out of which 90 patients had received a review within 10 to 56 days after diagnosis. 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 9 July 2015

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 patients with learning disability. For example, 26 out of 34 patients had received at least one consultation, telephone consultation, or home visit with a GP between April 2014 and March 2015. The practice offered longer appointments for people with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.