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Needham Market Country Practice Good

Reports


During an inspection to make sure that the improvements required had been made

This practice is rated as good overall. At our last inspection 3 May 2018, the practice was rated as good overall, with requires improvement for providing responsive services. This was because results from the July 2017 annual national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was below local and national averages. Patient access by telephone was difficult, with patients often attending the practice in person to book an appointment. All the learning points from complaints had not been recorded or shared with the whole practice team. We undertook a desk based inspection on 20 August 2019 to check the practice had made improvements.

At this inspection we found:

  • The practice had reviewed and improved access for patients accessing the practice by telephone. The practice could demonstrate the increased uptake of eConsult, an online service, with 19 consultations per week in January 2019, to 305 per week in August 2019. With the increase of patients using this service, the number of calls to the practice per month had reduced by 401, from March to July, which had reduced the pressure on the telephone system. The practice manager advised this had generated appointment capacity for patients who did need a face to face appointment.
  • The practice obtained patient feedback from surveys, Healthwatch Suffolk and community advocate engagement, and made changes to the service based on that feedback. All available reception staff prioritised answering the telephone and worked at the reception desk at times of peak patient demand and additional staff had been recruited to work on busier days.
  • Patient feedback obtained through the national GP patient survey had improved; there was no statistical variation between the practice and CCG and England averages for indicators which related to access.
  • The practice had a three month service plan which included initiatives to improve patient feedback, maximise the use of the eConsult system and complaint handling. Actions were discussed at weekly partner meetings and the plan was monitored and updated.
  • The practice had improved the documentation of meetings. Meeting minutes we reviewed were sufficiently detailed to ensure staff who had not been present would receive the information.
  • Learning from complaints and significant events were recorded and we saw evidence these were shared with the practice team.
  • 36 out of 44 patients with a learning disability had received a health check within the last 12 months. Four of the eight remaining patients had an appointment booked in September 2019. The practice had met with the learning disability nurse to improve the service they offered. The practice undertook some health checks in the patient’s home and sent a letter and telephoned patients before their appointment to increase uptake.

The areas where the provider should make improvements are:

  • Continue to drive improvements for patients accessing the practice by telephone.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of General Practice

Review carried out on 6 June 2019

During an annual regulatory review

We reviewed the information available to us about Needham Market Country Practice on 6 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 26 March 2018

During a routine inspection

This practice is rated as Good overall. At the previous Care Quality Commission (CQC) inspection in February 2016, the practice received requires improvement overall. A further inspection was completed in January 2017, where the practice remained rated as requires improvement.

Our announced comprehensive inspection on 8 May 2017 was undertaken to ensure that improvements had been made following our inspections carried out in February 2016 and January 2017, the practice received a good rating overall.

We carried out an announced comprehensive inspection at Needham Market County Practice on 26 March 2018 as part of our inspection programme.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

At this inspection we found:

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided through clinical audit. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • Data from the Quality and Outcomes Framework showed patient outcomes in many areas were above the national averages. To ensure this was managed well, the practice had increased clinical oversight into reviewing, improving, and monitoring their performance.

  • All patients had a named GP who took responsibility for their care. The practice prioritised continuity of care and patients were encouraged whenever possible to see their named GP

  • Staff told us they were happy to work at the practice and felt supported by the management team. Staff told us they were encouraged to raise concerns and share their views.

  • Results from the July 2017 national GP patient survey were generally in line with or above local and national averages.

  • Patients and staff told us that telephone access could be difficult and patients often attended the practice in person to book their appointments. On the day of the inspection we observed that there was a large queue of patients at the practice waiting for the practice to open. Patients that we spoke with and comment cards that we received advised us that they attended the practice in person because it is easier than attempting to access the practice by telephone. The practice had recently updated their telephone system and the practice informed us that they had plans to further develop their telephone system.

  • Information on the complaints process was available for patients at the practice and on the practice’s website. There was an effective process for responding to and investigating complaints and responses to patients were made in a timely manner. However, learning points identified were not always recorded or shared with the whole team staff.

  • The practice held various meetings including clinical and non-clinical. Minutes were taken but these did not always contain sufficient detail to ensure staff who had not been present would receive the information.

  • The practice had implemented a suite of practice specific policies and procedures which staff had read and were using. We saw a new practice intranet system was in place and this was in the process of being fully populated safely and systematically.

The areas where the provider should make improvements are:

  • Review and improve the systems and processes to ensure that information and learning is shared with the whole practice team including information from complaints and significant events.

  • Improve the take up of health checks for patients with a learning disability.

  • Review and improve access for patients accessing the practice by telephone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 6 April 2017

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Needham Market Country Practice on 1 December 2015. The overall rating for the practice was requires improvement.

We undertook a focused follow up inspection on 24 November 2016 where we found some breaches of legal requirements were still in place and a warning notice was served for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Good Governance.

You can read these reports by selecting the ‘all reports’ link for Needham Market Country Practice on our website at www.cqc.org.uk.

We undertook a focused follow up inspection on 6 April 2017 to check that the practice had taken urgent action to ensure they met the legal requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance.

This report covers our findings in relation to the warning notice in addition to other issues identified at the previous inspections and to confirm they meet legal requirements.

Our key findings on 24 November 2016 were:

  • We found that safety systems had been improved but these needed to improve further.
  • We found that practice staff had received appropriate chaperone training but not all staff had received a Disclosure and Barring Service check.
  • Not all practice staff had received infection prevention and control training.

There were also areas identified that we told the provider they should improve:

  • Embed and monitor the recently introduced policies and procedures into the working of the practice.
  • Ensure accurate records are kept in relation to the immunisation status of all appropriate staff including locum GPs.

Our key findings on 6 April 2017 were as follows:

  • Safety systems had been improved further with risk assessments and training in place.
  • All staff who undertook chaperoning had received a Disclosure and Barring Service check.
  • All practice staff had received infection prevention and control training.
  • Accurate records were kept in relation to the immunisation status of all appropriate staff including locum GPs.

However, there were also areas of practice where the provider continually needs to make improvements; the provider should:

  • Ensure that staff continue to receive appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.
  • The provider should continue to ensure the new protocols and methodologies are embeded to maximise the appropriateness, workability and sustainability of the new systems and processes
  • Ensure that learning identified from complaints is shared with all the staff members in the practice.

Overall the practice is now rated as Good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 24 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Needham Market Country Practice on 24 November 2016. This inspection was in follow up to our previous comprehensive inspection at the practice on 1 December 2015 where improvements were identified. The overall rating of the practice following the December 2015 inspection was requires improvement. We issued requirement notices to the practice to inform them where improvements were needed. After the December 2015 inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to ensuring services were safe.

Our key findings across all the areas we inspected were as follows,

  • The practice had employed a practice manager to assist the partners with the management of the practice. This staff member had been in post since April 2016. The practice staff told us that this had led to positive improvements.

  • Some risk assessments had been carried out but there was scope for these to be improved further. For example, the practice had not undertaken a written fire safety risk assessment at the branch sites.

  • The practice had improved the fire safety at the main site and regular fire drills were undertaken. However the fire risk assessment undertaken did not contain sufficient detail for the practice to be assured that patients and staff would be kept safe. For example, only four risks were assessed: source of ignition, storage of oxygen cylinder, electrical items, and keeping emergency exits clear. The risk assessment did not include the potential risks to patients with limited mobility during evacuation.

  • Not all actions from risk assessments had been identified and completed. For example, the practice had recognised that the temperature of individual water heaters was below the required level and had adjusted the thermostats but they had not monitored the water temperature to ensure it was safe.

  • The practice had identified two clinical leads for infection prevention and control and improvements had been made. Further improvements were required to meet the requirements as detailed in the Health and Social care Act 2008; Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

  • Practice staff who acted as chaperones had received appropriate training. However, the practice had not followed their own policy and non-clinical practice staff, who performed chaperone duties, had not received a Disclosure and Barring check. The practice submitted a request for these on the day of the inspection.

  • The practice had engaged a specialist company to check and calibrate the medical equipment.

  • The practice had improved the management of complaints and recorded all feedback however minor.

  • Practice staff had received some training deemed mandatory, for example, fire safety, but non-clinical staff had not received training such as infection prevention and control training.

  • With the exception of the dispensary staff members, the practice had not undertaken annual appraisals for non-clinical or nursing staff.

  • The practice had recently written 106 new policies and procedures and they were in the progress of training staff members how to access these via the electronic system. Further training sessions and meetings were planned to embed these further into the culture of the practice.

  • Some of the changes implemented can only be assessed once the new methodology has been put into practice, then the appropriateness, workability and sustainability of the new systems and processes can be determined.

Areas where the practice must make improvements;

  • Further improve the risk assessments undertaken at the practice with sufficient detail to ensure identified risks are mitigated and actions are taken to keep patients and practice staff safe from harm.

  • The practice must follow its policy and ensure that all staff who undertake chaperone duties receive a Disclosure and Barring Service check.

  • Ensure that staff receive appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

Areas the practice should make improvements;

  • Embed and monitor the recently introduced policies and procedures into the working of the practice.

  • Ensure accurate records are kept in relation to the immunisation status of all appropriate staff including locum GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 1 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Needham Market Country Practice on 1 December 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents. Information about safety was recorded, monitored, and appropriately reviewed. Learning was applied from events to enhance future service delivery.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. This was kept under review by the practice which proactively used audit as a way of ensuring that patients received safe and effective care.

  • There were clear policies and protocols for the management and dispensing of medicines from the practice.

  • Regular liaison meetings were held with the wider multi-disciplinary team to co-ordinate the provision of effective and responsive care. There was evidence of collaborative working including end of life care and safeguarding.
  • Members of the practice team had received an annual appraisal and had undertaken training appropriate to their roles. However not all staff felt their training needs had been identified at their appraisal and the new in post infection control lead felt they were not trained to the appropriate level.
  • Results from the national GP survey, and responses to our conversations with patients showed that patients were treated with compassion, dignity and respect, and that they were involved in their care and decisions about their treatment.
  • The practice worked closely with other services and organisations in the locality, and across the CCG area to plan and review how services were provided to ensure that they met people’s needs.
  • Urgent appointments were available on the day they were requested. However, patients said that they sometimes had to wait a long time to see the GP of their choice.
  • There was a clear GP leadership structure and staff felt supported by partners.
  • The practice proactively sought feedback from patients, which it acted upon. Patients responding to the national patient survey reported a positive experience at this practice, as did patients we spoke with on the day of our inspection.

We saw one area of outstanding practice:

  • A team of patient volunteers ran a free delivery service from the practice dispensary. Delivering patients medicines to elderly or vulnerable patients living in rural and isolated areas who were unable to attend the surgery. Staff told us they were often alerted to vulnerable patients concerns by the team of volunteers.

However there were areas of practice where the provider must make improvements:

  • Ensure infection control leads are trained to the appropriate level and regular infection control audits were being carried out.

  • Ensure building flooring met national guidance and building cleaning was being audited to ensure hygiene was being maintained.

  • Ensure staff have appropriate up to date policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.

  • Ensure calibration of medical equipment is carried out.

In addition there were areas of practice where the provider should make improvements:

  • Regular fire drills should be undertaken.

  • There was scope to improve the management of cleaning schedules through formal monitoring.

  • Ensure that staff who act as chaperones have been trained in accordance with the recent best practice guidelines.

  • Record verbal complaints in order to ensure shared learning.

  • Ensure risk assessments are undertaken in sufficient depth and a comprehensive record is kept of these.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice