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Inspection Summary


Overall summary & rating

Good

Updated 17 February 2017

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at Petworth Surgery on 7 June 2016. The overall rating for the practice was good. However, during this inspection we found a breach of legal requirements and the provider was rated as requires improvement under the safe domain. The full comprehensive report for the June 2016 inspection can be found by selecting the ‘all reports’ link for Petworth Surgery on our website at www.cqc.org.uk.

Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

  • Ensuring that all significant events were fully recorded centrally at the practice and a comprehensive audit trail was maintained.
  • Improving policies and procedures to ensure that blank prescription forms were monitored and tracked and improving security arrangements for access to controlled drugs.
  • Ensuring robust arrangements were in place for the management of infection control and for the assessment, monitoring and minimising of associated risks. This included staff receiving training on infection control and cleaning was recorded according to a defined schedule.
  • Ensuring that recruitment checks were completed, including proof of identification and references.
  • Ensuring non-clinical staff were either risk assessed or had received a Disclosure and Barring Scheme (DBS) check (especially for those who acted as chaperones).

This inspection was an announced focused inspection carried out on 25 January 2017 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 7 June 2016. The focused inspection has determined that the provider was now meeting all requirements and is now rated as good under the safe domain This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

  • Significant events were fully recorded centrally and discussed at regular meetings with actions recorded and dated. There was a comprehensive audit trail and electronic copies were available as well as paper copies which were stored centrally so they could be referred to if necessary.
  • The practice was monitoring and tracking blank prescription forms including when prescriptions were delivered to the practice and when disseminated to the individual doctor’s rooms. The practice was reconfiguring the layout of the dispensary and reception area. We saw this would allow for greater security and improve confidentially. Controlled drugs were stored in a locked cabinet within a second locked cabinet. Keys to both these cabinets were stored within a key safe which could only be accessed by authorised staff.
  • The practice had a new infection control lead who was the practice nurse. We saw evidence of training and the attendance of various forums for infection control. Infection control audits were undertaken every six months and there had been a recent Infection control audit in January 2017. We saw that actions had been recorded to address any concerns found. The practice had also employed a new cleaning company and we saw daily cleaning plans which were dated and signed. There was a dedicated cleaning folder where we saw evidence of daily, weekly and monthly cleaning schedules for various elements of the practice. All staff had received training on infection control which included hand washing.
  • We reviewed the latest recruitment file for a new employee at the practice and found that it contained all the required information. For example, a full works history, Disclosure and Barring Scheme (DBS) check, proof of identification and references.
  • We saw minutes to a meeting where the practice had discussed which roles were required to have a Disclosure and Barring Scheme (DBS) check. We saw evidence that all those staff members who were also acting as chaperones had received a DBS check and that a new risk assessment was in place for those who were not required to have one.

In addition we saw evidence of:

  • The new practice manager, who had been in post since November 2016, was reviewing all policies and procedures and ensuring they were up to date and relevant. Policies which had been reviewed contained the last review date.
  • The practice was in the process of completing building work to change the layout of the dispensary. This would ensure restricted access with the dispensary only being accessed by authorised staff.
  • The practice manager had a training matrix which recorded staff members and their completed training. The practice manager was also able to access training logs and certificates of training from the e-learning training tools that were used.
  • Complaints were a standing item on the weekly meetings and the bi-monthly strategy meetings and information was recorded with dates and actions taken. We saw these were recorded electronically as well as paper copies being stored centrally so they could be referred to if necessary.
  • The practice had a variety of meetings for staff. This included weekly meetings, nurse meetings and bi-monthly development meetings. There was also a bi-monthly strategy meeting with the partners and regular meetings with the administration staff. The practice manager informed us that there were plans in place for a weekly huddle meeting with key staff members to ensure important information was disseminated. This ensured that all staff were kept up to date with changes with the practice and had a forum to raise questions or concerns.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 February 2017

At our previous inspection in June 2016 the practice had been rated as requires improvement for providing safe services. Concerns related to significant events, blank prescription form tracking, infection control, access to controlled drugs and recruitments checks including disclosure and barring checks.

At this focussed inspection in January 2017, we found the provider had addressed our concerns and is now rated as good.

  • Significant events were fully recorded centrally and discussed at regular meetings with actions recorded and dated. There was a comprehensive audit trail and electronic copies were available as well as paper copies which were stored centrally so they could be referred to if necessary.
  • The practice was monitoring and tracking blank prescription forms including when prescriptions were delivered to the practice and when disseminated to the individual doctor’s rooms. The practice was reconfiguring the layout of the dispensary and reception area. We saw this would allow for greater security and improve confidentially. Controlled drugs were stored in a locked cabinet within a second locked cabinet. Keys to both these cabinets were stored within a key safe which could only be accessed by authorised staff. .
  • The practice had a new infection control lead who was the practice nurse. We saw evidence of training and the attendance of various forums for infection control. There had been a recent Infection control audit and we saw that actions had been recorded to address any concerns found. Infection control was a standing item on the weekly meeting agenda. The practice had also employed a new cleaning company and we saw daily cleaning plans which were dated and signed. There was a dedicated cleaning folder where we saw evidence of daily, weekly and monthly cleaning schedules for various elements of the practice. All staff had received training on infection control which included hand washing.
  • We reviewed the latest recruitment file for a new employee at the practice and found that it contained all the required information. For example, a full works history, Disclosure and Barring Scheme (DBS) check, proof of identification and references.
  • We saw minutes to a meeting where the practice had discussed which roles were required to have a Disclosure and Barring Scheme (DBS) check. We saw evidence that all those staff members who were also acting as chaperones had received a DBS check and that a new risk assessment was in place for those who were not required to have one.

Effective

Good

Updated 15 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • All patients had a named GP; however the practice had a formal buddy system to ensure that each patient had a second GP to ensure continuity of care.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 15 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed 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 staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 15 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff 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. For example they were collaborating with other local practices to discuss setting up an urgent care clinic.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included a portable hearing loop, disabled facilities and baby changing facilities.

  • The practice regularly attended to the residents of nearby care homes to provide services that included medicine reviews and health checks. We received positive feedback from one of the care home managers about the care and treatment received.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 15 September 2016

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

  • The practice 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 it.

  • The practice management and all staff considered patient care to be their top priority and demonstrated a focus on knowing their patients individually, in order to provide continuity of care.

  • There was a clear leadership structure and staff felt supported by management. The practice held regular governance meetings and had a number of policies and procedures to govern activity, although not all were dated.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was relatively new but we were given examples of improvements that had been made and were planned.

  • There was a strong focus on continuous learning and improvement at all levels. This included that the GPs had a shared office in order to facilitate information sharing, case reviews and general assistance. The registrars would also work from this room and therefore benefited from unrestricted time with more experienced GPs and partners.

Checks on specific services

People with long term conditions

Good

Updated 15 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.

  • Performance for diabetes related indicators were in line or slightly above with national averages. For example, the percentage of patients with diabetes who had a record of a foot examination and risk classification within the preceding 12 months was 90% compared with a national average of 88%.

  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a 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.
  • The practice offered a range of services to people with long term conditions. This included clinics for diabetes, asthma and hypertension.

Families, children and young people

Good

Updated 15 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 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.
  • The practice’s uptake for the cervical screening programme was 76%, which was comparable to the CCG average of 76% and the national average of 74%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 15 September 2016

The practice is rated as good for the care of older people.

  • All patients had a named GP, including those over 75.
  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice regularly attended to the residents of a nearby care home to provide regular services that included medicine reviews and health checks. We received positive feedback from the manager of one of these care homes.

Working age people (including those recently retired and students)

Good

Updated 15 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.
  • 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 was proactive in offering online services including booking/cancelling appointments and an electronic prescribing service.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 September 2016

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

  • Data from the Quality and Outcomes Framework (QOF) showed results were in line with national averages for this population group. For example the percentage of patients diagnosed with dementia whose care had been reviewed in the preceding 12 months was 80% which was in line with the national average of 84%.
  • 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 advance care planning for patients with dementia. We saw evidence of detailed and personalised care plans for patients experiencing poor mental health.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice 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 patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 15 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 patients 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. The practice had designated the senior partner as the lead member of staff for safeguarding, who had recently attended a safeguarding update and attended a meeting for safeguarding leads annually.