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Inspection Summary


Overall summary & rating

Good

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Phoenix Surgery on 1 September 2016. We found that the practice required improvement for the provision of safe services because improvements were needed in the way the practice managed medicines, including emergency medicines and vaccines, as arrangements did not always keep patients safe. The overall rating for the practice was good.  The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Phoenix Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 3 April 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 on 1 September 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

  • Temperatures were being appropriately monitored in all areas where medicines were stored.
  • A fridge that was suitable for storing medicines which measured minimum and maximum temperatures, in line with national guidance, had been purchased for the dispensary at Kemble.
  • Policies relating to repeat prescribing had been updated and adhered to.
  • Medicines and blank prescriptions were being stored securely.
  • Policies relating to patient specific directives had been updated and adhered to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 26 April 2017

At our previous inspection on 1 September 2016, we rated the practice as requires improvement for providing safe services as the arrangements for managing medicines, including emergency medicines and vaccines, did not always keep patients safe.

These arrangements had significantly improved when we undertook a follow up inspection on 3 April 2017. The practice is now rated as good for providing safe services.

Specifically we found:

  • A fridge that was suitable for storing medicines which measured minimum and maximum temperatures, in line with national guidance, had been purchased and was in use at the dispensary at Kemble.
  • We were shown logs of temperature monitoring of all fridges and also room temperatures of Kemble dispensary.
  • Medicines and blank prescriptions were being stored securely.
  • Standard operating procedures for use by dispensary staff had been reviewed, updated and signed by relevant staff. Systems were in place to ensure that procedures were adhered to regarding dispensing of repeat prescriptions.
  • We saw evidence that a quality improvement activity had been carried out regarding the administration of medicines under patient specific directions. Minutes of meetings demonstrated that the actions had been reviewed, implemented and that the updated standard operating procedures were being adhered to. This ensured safe administration of medicines to patients by non-prescribing health professionals.

Effective

Good

Updated 26 April 2017

Caring

Good

Updated 26 April 2017

Responsive

Outstanding

Updated 26 April 2017

Well-led

Good

Updated 26 April 2017

Checks on specific services

People with long term conditions

Good

Updated 14 November 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.

  • The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 94% compared to a local average of 90% and a national average of 88%.

  • The practice effectively managed patients with long term conditions in the community setting. Continuity of care, by having personalised lists, regular reviews in the practice and the employment of a nurse practitioner to identify and mange those requiring additional support had led to the practice reducing hospital admissions of these patients to nearly half the local and national average.

  • 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.

Families, children and young people

Outstanding

Updated 14 November 2016

The practice is rated as outstanding 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 percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years (01/04/2014 to 31/03/2015) was 84% which was the same as the local average of 84% and above the national average of 82%.

  • 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.

  • The practice had identified the need for a young person friendly service that offered advice and support for all aspects of teenage health, but with a significant focus on adolescent mental health and sexual health, which was accessible to all young people irrespective of where they lived or which GP practice they were registered with. The scheme called “Indigo” was led by a GP who worked collaboratively with all interested parties, for example, local schools and colleges, youth services, chemists and sexual health clinics to ensure young people had the information they needed to access health care support. Drop in clinics were provided at the practice and led by two nurses with the necessary skills and experience. The service also provided support and information to parents to help them discuss difficult issues, such as drugs, alcohol and eating disorders with their children.

Older people

Good

Updated 14 November 2016

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 participated in social prescribing as a way to link older patients in primary care with sources of support within the community. It provided the practice with a non-medical referral option that could operate alongside existing treatments to improve health and well-being.

  • The practice had implemented a scheme called “Staywell” and employed a nurse practitioner to lead on the scheme. Patients over 75 years of age, where early identification could reduce potential problems leading to further deterioration and prevent unnecessary hospital admissions were identified, using a nationally recognised frailty score. Collaborative working with other health professionals, social care and voluntary agencies was integral to providing services at the right time and the right place and ensured the service was tailored to meet the individual needs of each patient. The service had benefitted patients in a number of ways. For example, increased patient and family satisfaction, earlier identification and case management of vulnerable patients, reduced hospital admissions and improved social support. The success of the scheme had led to the clinical commissioning group adopting this model throughout the locality

Working age people (including those recently retired and students)

Good

Updated 14 November 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 offered extended GP and nurse hours to provide improved accessibility for those patients who worked.

  • 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.

  • There were daily surgeries including at the branch practice based at the local university to ensure good access for students.

  • The practice was continually working to improve access for working age patients and had piloted skype consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 November 2016

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

  • The percentage of patients with a serious mental illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 95% compared to a local average of 93% and a national average of 88%.

  • 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 14 November 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. Health checks were delivered by the health care assistants.
  • 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 a register of carers and supported them to receive appropriate support