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Inspection Summary


Overall summary & rating

Good

Updated 15 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Vitty, Pfeiffer and Berni on 10 February 2016. Breaches of legal requirements were found. We found breaches of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the regulations). Warning Notices were issued in respect of Regulation 12 and Regulation 17 of the regulations. Requirement Notices were issued in respect of Regulations 18 and 19 of the regulations. The provider was required to make improvements and to submit an action plan detailing how they would make those improvements by 27 May 2016.

This focussed inspection on 15 June 2016 was to check that improvements required had been implemented and that the terms of each Warning Notice and the Requirment Notices had been met.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Drs Vitty, Pfeiffer and Berni on our website at www.cqc.org.uk.

The reference to the practice throughout this report refers to the practice now known as Drs Berni and Vitty, following the retirement of one of the GP partners, Dr Pfeiffer.

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

The provider had met the requirements to improve.

  • Improvements to protect patients from harm had been implemented. We found systems and processes in place that promoted patient safety. For example, recruitment checks had been reviewed and checks required on all staff were now in place. Essential training for staff had been delivered and a comprehensive training matrix was in use which identified when staff were due for follow-up or refresher training.

  • Significant events were now being routinely reported, recorded and investigated. The subject of significant events was now a standing agenda item for practice meetings and clinical meetings. All staff had received training in significant events and understood that reporting and recording these promoted safety within the practice.

  • Improvements to the practice treatment and consulting rooms had been made to enable the practice to better comply with infection control standards. All rooms and the patient waiting and reception areas were fitted with sealed flooring; all consulting and treatment rooms were fitted with compliant sinks. Privacy curtains that were disposable were fitted round all examination couches. We saw that cleaning schedules were in place for all areas of the practice and the standard of cleaning was reviewed on a daily basis by the infection control lead or the appointed deputy.

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • 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 provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. All staff had a good understanding of what constituted a significant event and how learning from events should be shared.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • Patients medications were being reviewed systematically; staff raised queries with GPs were there was evidence of patients non-compliance with medicines regimes.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Recruitment checks had been reviewed and checks required on all staff were now in place.

  • Training for all staff had been delivered

  • Risks to patients were assessed and well managed.

  • Work had been carried out on the practice premises to ensure patient and staff safety.

  • Upgrades to clinical rooms had been carried out to enable better compliance with infection control requirements.

  • All vaccines and emergency medicines were safely and securely stored.

Effective

Good

Updated 15 July 2016

The practice is rated as good for providing effective services.

  • Improvements to the way in which patient correspondence was handled had been embedded and all staff followed a clearly defined protocol.

  • Effective systems were in place to monitor the standard of cleaning at the practice.

  • Clinical audits demonstrated quality improvement; the practice had done repeat audit cycles which demonstrated that care of patients in relation to weight management, lifestyle and diabetes management had provided positive results.

  • We saw evidence of positive working with the CCG medicines management teams which contributed to effective medicines management.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment; all required training had either been received or was planned for delivery imminently.

  • 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 July 2016

Responsive

Good

Updated 15 July 2016

Well-led

Good

Updated 15 July 2016

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

  • There were sufficient processes and procedures in place for staff to follow and to keep patients safe. The governance framework at the practice had been improved.

  • There had been a change in Registered Manager at the practice; the new Registered Manger fully understood the scope of their responsibilities.

  • Patient information leaflets had been updated to provide information on surgery hours as well as opening hours of the practice. Results of the Friends and Family Test each month were made available in patient information areas.

  • There was a plan for regular staff and clinical meetings at the practice which included multi-disciplinary meetings. These meetings were minuted and minutes were available for review by any staff members unable to attend.

  • There was a clear leadership structure and staff felt supported by management.

  • Plans for a merger with another practice were in place and the updating of systems, processes and procedures had taken account of this.

Checks on specific services

People with long term conditions

Good

Updated 15 July 2016

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

  • Our previous inspection findings from February 2016 showed that aspects of the safe, effective and well-led domains impacted on the care of all population groups. Improvements made since then have improved patient care in all population groups.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Nursing staff had the skills, qualifications, experience and training needed to meet the needs of this patient group.

  • 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.

  • Where previously we had found medications errors in the treatment of patients with long term conditions, we found improvements had been made. These patients were systematically reviewed to ensure the prescribed treatment met their needs, that they understood the importance of compliance with the course of treatment and that they took medicines safely.

Families, children and young people

Good

Updated 15 July 2016

The practice is rated as good for the care of families, children and young people.

  • Our previous inspection findings from February 2016 showed that aspects of the safe, effective and well-led domains impacted on the care of all population groups. Improvements made since then have improved patient care in all population groups.

  • 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.

  • Recruitment of the two salaried female GPs and the planned addition of a female GP partner, provided patients with improved access to female GPs.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 15 July 2016

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

  • Our previous inspection findings from February 2016 showed that aspects of the safe, effective and well-led domains impacted on the care of all population groups. Improvements made since then have improved patient care in all population groups.

  • 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 skills of the clinical staff, including the recruitment of the two salaried female GPs and the planned addition of a female partner, provided patients with improved access to female GPs.

  • A systematic system of review of patients longer term medications was in place, which kept patients safe.

Working age people (including those recently retired and students)

Good

Updated 15 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • Our previous inspection findings from February 2016 showed that aspects of the safe, effective and well-led domains impacted on the care of all population groups. Improvements made since then have improved patient care in all population groups.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 July 2016

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

  • Our previous inspection findings from February 2016 showed that aspects of the safe, effective and well-led domains impacted on the care of all population groups. Improvements made since then have improved patient care in all population groups.

  • 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.

  • 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 July 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 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.