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Inspection Summary


Overall summary & rating

Good

Updated 9 April 2019

This practice is rated as Good overall and in the safe domain. (Previously inspected December 2017 where it was rated as good overall and requires improvement in safe)

From the inspection in December 2017 the practice was told they must:

  • Safe care and treatment must be provided in a safe way to patients, including the proper and safe management of medicines and acting on all medicine alerts.
  • Review their significant event reporting and investigation process following incidents that affect the health, safety and welfare of people using the service.
  • Review their process in managing the use of prescription forms throughout the practice so as to mitigate risk.

The full comprehensive report can be found by selecting the ‘all reports’ link for The Fairlands Practice on our website at www.cqc.org.uk.

This inspection was an announced follow up inspection carried out on 13 March 2019, 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 on December 2017. This report covers our findings in relation to those improvements made since our last inspection.

Our judgement of the quality of care at this service is based 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.

The practice is rated as good overall and good for all the population groups.

The key question is now rated as:

Are services safe? – Good

At this inspection we found: -

  • There was a system for the tracking of prescription stationery throughout the practice.
  • We checked the emergency response bag and found all medicines were within their expiry date. There was a recorded monthly check carried out by the nurses.
  • Any errors in dispensing medicines were recorded and investigated.
  • The dispensary had processes for collecting near-miss error data.
  • Dispensary staff showed us standard operating procedures which covered all aspects of the dispensing process (written instructions about how to safely dispense medicines). We saw evidence of regular review of these procedures.
  • The controlled drug register was correctly completed and there was evidence to demonstrate that expiry dates and balance checks of medicines were being undertaken.
  • Significant events were recognised and recorded as such.
  • The dispensary team were informed of medicine alerts and acted appropriately, which included having their own folder to retain alerts and recording action taken. This was detailed in the standard operating procedures.

The areas where the provider should make improvements are:

  • Review how the practice could provide information in accessible formats.
  • Review other avenues of learning to support the dispensary staff with their development.

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 areas

Safe

Good

Effective

Good

Caring

Good

Responsive

Good

Well-led

Good
Checks on specific services

People with long term conditions

Good

Updated 23 April 2015

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

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. 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.

The practice provided a range of services that included the management of long-term conditions, and clinics covering a wide range of services for patients include asthma/COPD clinics, diabetes clinics, hypertension clinics, weight management services, smoking cessation advice, blood pressure monitoring, blood tests, ECGs, vaccinations as well as travel health, safe travel tips, travel vaccinations, blood tests, and x-rays.

Families, children and young people

Good

Updated 23 April 2015

The practice is rated as good for 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. We saw good examples of joint working with midwives, health visitors and school nurses.

A range of services were provided for families, children and young people. There were clinics covering a wide range of services for patients including asthma/COPD clinics, diabetes clinics, hypertension clinics, well woman/man checks, family planning services, weight management services, smoking cessation advice, blood pressure monitoring, blood tests, ECGs, vaccinations and immunisations, maternity care, and child development as well as travel health, safe travel tips, travel vaccinations, blood tests, and x-rays.

One of the GPs had an interest in women’s health, family planning and paediatrics. Another GP was working towards a Diploma in Sexual and Reproductive Health.

The practice had no specific lead for travellers. However, they had high users of their practice within the traveller community. The practice had success in offering immunisations. The practice was able to demonstrate a high level of knowledge of the traveller community.

The practice had a link on its website to the Fairlands and Normandy Surgeries patient survey results, minutes of the patient group meeting and action plan. The Fairlands Patient Group comprised of 76 virtual members and the report detailed the characteristic of the group. The information included; attendance, gender, ethnicity, and age. The survey was overseen by the practice manager and the patient representative and was test driven and feedback provided by another patient. The survey was made available and promoted via the practice website and at both the practice locations by the practice’s reception team in hard copy throughout February 2014. The receptionists were encouraged to actively promote the survey to the practice’s younger patients (under 25). The practice found that it was difficult to engage this patient group. The practice has asked GPs to target under 25s and encourage them to speak to the practice manager and or join the virtual group to provide some feedback on the services offered and their relevance to teenagers and young adults.

Older people

Good

Updated 23 April 2015

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

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 and rapid access appointments for those with enhanced needs.

Nationally reported data showed that the practice had more than the clinical commissioning group (CCG) average for people aged 65 plus and 75 plus. They had marginally fewer than the CCG average for 85 plus. The practice had a slightly than higher average deprivation score for older people than the CCG average. The practice had a small nursing home population. The life expectancy of the people using the practice was slightly higher than for the CCG area.

The practice offered a range of services which benefited older people. This included management of long-term conditions, and clinics covering a wide range of services for older patients including asthma/ chronic obstructive pulmonary disease (COPD) clinics, diabetes clinics, hypertension clinics, well woman/man checks, weight management services, smoking cessation advice, blood pressure monitoring, blood tests, ECGs, vaccinations and immunisations, as well as travel health, safe travel tips, travel vaccinations, blood tests, and x-rays.

One of the GPs within the practice was the named GP responsible for a large local care home and conducted a routine ward round there on a weekly basis. The care home had patients with very complex needs. There was a high turn-over of patients. The GP involved relatives as much as possible. The practice had employed a locum to allow extra time to undertake the care planning process. Thirty minute appointments were arranged to enable time to construct the care plans.

The practice had a lead for unplanned admissions and a frailty register based on all patients in residential care over the age of 85 years old. These patients were known to each GP.

The practice was involved with the Gold Standards Framework. This is an initiative to improve primary palliative care.

However the practice was an outlier for a regular (at least three monthly) multidisciplinary case review meeting where all patients on the palliative care register are discussed.

Working age people (including those recently retired and students)

Good

Updated 23 April 2015

The practice is rated as good for 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 open 8am to 6.30pm on weekdays. The reception desk opened for patients (other than those with scheduled appointments) at 8.30am. This was due to the large number of telephone calls early in the morning. The reception was occasionally closed to calls between 1pm and 2pm. The practice had a branch surgery in Normandy. The opening hours for the branch surgery were 8am to 5pm. The practice had run a GP and nurse surgery from 9am to 12pm on Saturdays. These surgeries were strictly by appointment only and the practice’s telephone lines are not open during those hours.

There were a range of services for working age people (including those recently retired and students). The services include management of long-term conditions, and clinics covering a wide range of services for patients including asthma/COPD clinics, diabetes clinics, hypertension clinics, well woman/man checks, family planning services, weight management services, smoking cessation advice, blood pressure monitoring, blood tests, ECGs, vaccinations and immunisations, maternity care, and child development as well as travel health, safe travel tips, travel vaccinations, blood tests, and x-rays.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 April 2015

The practice is rated as good for people experiencing poor mental health (including people with dementia). People experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advanced 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 (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

The practice provided a range of services for people experiencing poor mental health (including people with dementia) that included management of long-term conditions, and clinics covering a wide range of services for patients including asthma/COPD clinics, diabetes clinics, hypertension clinics, well woman/man checks, family planning services, weight management services, smoking cessation advice, blood pressure monitoring, blood tests, ECGs, vaccinations and immunisations, maternity care, and child development as well as travel health, safe travel tips, travel vaccinations, blood tests, and x-rays.

The practice had a GP lead for mental health. The practice was aware of patients experiencing poor mental health. The practice offered appointments for counselling for people experiencing poor mental health. The practice ensured that patients experiencing poor mental health got physical health checks. The practice had care plans for patients experiencing poor mental health. The practice had experience of undertaking a number of Power of Attorney cases. They had also had experience of a patient who needed an Independent Mental Capacity Advocacy service. Advanced directives were rare in the practice’s experience. The practice had undertaken best interest principle work.

People whose circumstances may make them vulnerable

Good

Updated 23 April 2015

The practice is rated as good for people whose circumstances make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers, and those with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multidisciplinary teams in the case management of 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 a range of services for people whose circumstances may make them vulnerable including management of long-term conditions, and clinics covering a wide range of services for patients including asthma/COPD clinics, diabetes clinics, hypertension clinics, well woman/man checks, family planning services, weight management services, smoking cessation advice, blood pressure monitoring, blood tests, ECGs, vaccinations and immunisations, maternity care, and child development as well as travel health, safe travel tips, travel vaccinations, blood tests, and x-rays.

The practice had no specific lead for travellers. However, they had high users of their practice within the traveller community. The practice had success in offering immunisations. The practice was able to demonstrate a high level of knowledge of the traveller community. There are three local traveller sites.

The practice had links with bereavement counselling services.