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Oakham Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 23 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakham Medical Practice on 17 January 2017. The overall rating for the practice was good. The full comprehensive report on the 17 January 2017 inspection can be found by selecting the ‘all reports’ link for Oakham Medical Practice on our website at www.cqc.org.uk.

However at that inspection we found that:

  • Blank prescription pads were not being managed correctly.

  • Risks to patients and others had not been properly mitigated. There had been no inspection of fixed electrical wiring .

We issued the provided with requirement notices for breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice was rated as ‘requires improvement’ in the safe key question.

In addition we also found that:

  • The practice should address the issues highlighted in the national GP survey in order to improve patient satisfaction including access to appointments and ease of getting through to the practice by telephone.

  • The practice should review risk assessments in place for non-clinical members of staff who did not have a Disclosure and Barring Service (DBS) check to ensure the rationale for not requiring a DBS check was documented.

  • The practice should review processes in place in relation to clinical audits to ensure full cycle audits are carried out to improve patient outcomes.

  • The practice should review the system of appraisals to ensure all members of staff receive an appraisal at least annually.

This inspection carried out on 1 June 2017 was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 17 January 2017. This report covers our findings in relation to those requirements and to other improvements they had made.

Specifically we found that:

  • The practice had an effective system to manage the security of blank prescription forms.

  • The buildings had been inspected to help ensure their electrical safety.

  • The practice had taken action to address the low satisfaction scores for telephone access.

  • There was a clear and effective system in place to ensure that staff were subject to a DBS check or risk assessment where this was not the case.

  • The practice had carried out and were continuing to carry out full cycle clinical audits.

  • There was an effective system to ensure all staff received an annual appraisal.

Overall the practice is rated as ‘Good’. It is also rated as ‘Good’ in the safe key question.

It was already rated as ‘Good’ in the effective and responsive key questions and these ratings have not changed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 June 2017

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed. The surgery buildings had an up to date electrical condition report.

  • The practice had implemented and embedded a process for ensuring the security of blank prescriptions.

  • There was a clear policy and risk assessment process in respect of DBS checks for all practice staff.

Effective

Good

Updated 23 June 2017

The practice is rated as good for providing effective services.

  • The practice had an effective program of clinical audit.

  • The practice had implemented and commenced annual appraisals for all staff.

Caring

Good

Updated 23 June 2017

Responsive

Good

Updated 23 June 2017

The practice is rated as good for providing responsive services.

  • The practice had responded to the concerns of patients regarding telephone access and had agreed a new telephony system to be operational within two to three months.

Well-led

Good

Updated 23 June 2017

Checks on specific services

People with long term conditions

Good

Updated 18 April 2017

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 was 100% which was the maximum amount of points available compared to the CCG average of 93% and the national average of 90%. (Exception reporting rate was 10% which was lower than the CCG average of 11% and the national average of 12%).

  • A practice nurse who specialised in the management of diabetes held in-house group classes to provide support and advice to patients with injectable diabetic medication.

  • 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 multi-disciplinary package of care.

Families, children and young people

Good

Updated 18 April 2017

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 73%, which was comparable to the CCG average of 78% and the national average of 74%.

  • 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.

  • Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages for example, childhood immunisation rates for the vaccinations given to five year olds ranged from 94% to 95%.

Older people

Good

Updated 18 April 2017

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

  • 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 encouraged its patients to attend national screening programmes for bowel and breast cancer screening.

  • All housebound patients had a care plan in place which was reviewed on a regular basis.

  • The practice engaged in a scheme funded by the CCG which included four other local practices whereby an integrated care co-ordinator employed by Rutland County Council worked in the practice two days per week. This co-ordinator worked specifically with patients both in-house and in the community who suffered with long term conditions or were frail and at risk of falls and had been identified as at risk of unplanned admission to hospital.

Working age people (including those recently retired and students)

Good

Updated 18 April 2017

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 provided on-line services for patients such as to book routine appointments and ordering repeat prescriptions.

  • The practice provided extended hours appointments on a Saturday.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 April 2017

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

  • Performance for mental health related indicators was 100% which was higher than the CCG average of 97% and the national average of 94%. (Exception reporting rate was 25% which was lower than the CCG average of 30% and higher than the national average of 11%).
  • 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 18 April 2017

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 held regular safeguarding meetings and reviewed vulnerable adults and children.