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Lakeside Healthcare at The New Queen Street Surgery Good Also known as Dr R M Scott and Partners

Inspection Summary


Overall summary & rating

Good

Updated 8 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The New Queen Street Surgery on 28 June 2016. The overall rating for the practice was good, and requires improvement in relation to providing safe services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The New Queen Street Surgery on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 23 May 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 28 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is rated as good, which includes providing safe services.

Our key findings were as follows:

  • The practice had created and appointed to a new dispenser post for 27.5 hours per week to improve dispensing services.
  • There was an effective system in place for reporting, recording, investigating, reviewing and learning from near misses in the dispensary.
  • Dispensing standard operating procedures for dispensing medicines, including controlled drugs (CDs) and dispensary stock, had been reviewed and updated. (Controlled Drugs are medicines that require extra checks and special storage requirements because of their potential for misuse).
  • Improvements had been made to ensure the dispensing process for medicines, including CDs was safe.
  • The practice had established a system for checking that medicines in the dispensary were in date. We reviewed documented records that these checks had been undertaken. These included checks of the controlled drugs and that the controlled drug register had been completed appropriately.
  • The practice had undertaken a planned fire drill in November 2016 and this had been documented. Future fire drills had been scheduled according to their fire safety policy.
  • The arrangements for the safe storage of clinical supplies had been reviewed. These were now kept in a locked storage room, to minimise the risk of unauthorised access.
  • The practice had increased the number of annual health checks undertaken for people with learning disabilities from 24% during 2014 to 2015 to 73% from 2016 to 2017. A dedicated administrator was now responsible for coordinating and booking the reviews. These were scheduled on the patient’s month of birth and a recall system was set up to monitor uptake. The practice had developed links with a learning disability link nurse who supported this work, which included the use of easy read information for inviting patients, informing them about the health check and a pre health check questionnaire.
  • The practice had established systems to monitor the practice appointment system and had made changes to increase effectiveness. The practice now offered a broader range of appointment times throughout the day and week and had increased the number of telephone appointments available for patients. Patients also had access to GP and nurse appointments from 6.30pm to 8pm Monday to Friday and from 9am to 5pm Saturday and Sunday at a central location in Peterborough. Patients from the practice could be booked an appointment through the practice computer system.

At our previous inspection on 28 June 2016, we rated the practice as requires improvement for providing safe services as systems and processes relating to the dispensing of medicine, including Controlled Drugs, were not always followed. (Controlled Drugs are medicines that require extra checks and special storage requirements because of their potential for misuse). At this inspection we found that improvements had been made. Consequently, the practice is rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 June 2017

At our inspection on 23 June 2016, patients were at potential risk of harm because systems and processes relating to the dispensing of medicine, including Controlled Drugs, were not always followed.

Our desk based inspection on 23 May 2017 found that improvements had been made.

  • The practice had created and appointed to a new dispenser post for 27.5 hours per week. Once the dispenser had qualified, the practice planned for a qualified dispenser to be available in the dispensary from 8am to 6pm every working day.
  • There was an effective system in place for reporting, recording, investigating, reviewing and learning from near misses in the dispensary.
  • Dispensing standard operating procedures for dispensing medicines, including controlled drugs (CDs) and dispensary stock had been reviewed, updated and signed by all dispensing staff. (Controlled Drugs are medicines that require extra checks and special storage requirements because of their potential for misuse). These reflected the safety improvements they had made since the previous inspection.
  • The practice had introduced a system of bar code scanning when medicine stock was entered on the computer system and when medicine was dispensed, to reduce the risk of dispensing errors. Checks by a second person were also in place when necessary.
  • The practice manager and a dispenser confirmed that all prescriptions for controlled drugs were printed as a paper prescription and signed by a GP, prior to being given to the dispensary for dispensing.
  • The practice had established a system for checking that medicines in the dispensary were in date. We reviewed documented records that these checks had been undertaken. These included checks of the controlled drugs and that the controlled drug register had been completed appropriately.
  • The practice had undertaken a planned fire drill in November 2016 and this had been documented. Future fire drills had been scheduled according to their fire safety policy.
  • The arrangements for the safe storage of nurse supplies had been reviewed. These were now kept in a locked storage room, to minimise the risk of unauthorised access.

Effective

Good

Updated 14 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mostly at or above average when compared to the national average. For example, the percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months (including an assessment of asthma control) was 77% compared to the CCG average of 76% and the national average of 75%. The rate of exception reporting was 3% compared to the CCG and national average of 8%.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • The practice undertook a comprehensive system of appraisal and personal development plans for all staff which included peer review. The practice hosted training sessions for their own staff and also made these available for staff members from other practices to attend.

  • Staff worked proactively with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 November 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice comparable to others for several aspects of care. For example, 84% said the GP was good at listening to them compared to the CCG average of 89% and national average of 89%.

  • Feedback from patients about their care was generally positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible. The practice produced a number of leaflets to help patients understand the range of services available at the practice, along with services available outside the practice.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice had identified 333 patients as carers which was 4.8% of the practice population. The practice provided support for carers through the local CCG Family Carers’ Prescription scheme.

Responsive

Good

Updated 14 November 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • Patients said they were able to make an appointment to see a GP or nurse, 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. The practice had a lift installed to allow access to upper floors of the surgery building for people who were unable to manage the stairs.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The practice undertook a comprehensive system of appraisal and personal development plans for all staff which included peer review. The practice hosted training sessions for their own staff and also made these available for staff members from other practices to attend.

  • The practice had introduced clinics for patients with more than one long term condition. For example, patients with conditions such as diabetes and heart disease had their annual reviews for both conditions at the same time. This saved the patient making four separate appointments.

Well-led

Good

Updated 14 November 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

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

  • The practice had a number of policies and procedures to govern activity, but some of these were not followed by staff. For example, activities outlined in policies governing activity for dispensing medicine were not always implemented.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken, although this required improvement in some areas. For example, near misses were not recorded in the dispensary and therefore could not be shared or trends identified.

  • The practice proactively sought feedback from staff and patients, which it acted on. The practice Patient Participation Group (PPG) worked well with the practice. For example, the PPG provided feedback regarding the practice phone system and appointment system and the practice was attempting to make improvements, including updating the phone system and introducing online appointment booking.

  • There was a focus on continuous learning and improvement at all levels within the practice. For example, the practice hosted programmes of training for all staff. The practice liaised with a training provider to undertake the training and made this available for other practices to attend.

  • The practice actively encouraged staff to mix in a non-formal environment. For example the practice encouraged all members of the practice team to attend lunch together.

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 practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 99%, which was above the CCG average of 90% and the national average of 89%. Exception reporting for diabetes related indicators was 20%, which was higher than the CCG average of 13% and the national average of 11% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

  • Longer appointments and home visits were available when needed.

  • 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

Good

Updated 14 November 2016

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.

  • Immunisation rates were in line or above CCG averages for standard childhood immunisations.

  • The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 81%, which was in line with the CCG and national averages of 82%.

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

  • The practice offered a full range of contraception services.

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 had a dedicated telephone line which was shared with staff from nursing homes, so that they were able to contact the practice quickly if necessary.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, heart failure, and chronic obstructive pulmonary disease were above local and national averages.

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 was proactive in offering online services such as online appointment booking and repeat prescription requests. The practice also offered a range of health promotion and screening that reflects the needs for this age group.

  • The practice provided both telephone and sit and wait appointments. The practice also offered eConsult (a system where a patient is offered a discussion with an appropriate clinician 24 hours a day and then offers the option of a patient completed consultation perform which is passed electronically to the practice to be dealt with within one working day.) This system also offered for example, general and specific health advice.

  • The practice offered pre-bookable appointments on Monday evenings this met the need of those patients who could not attend during the day.

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).

  • 81% of patients diagnosed with dementia had received a face to face care review in the last 12 months, compared to the CCG and national average of 84%.

  • 94% of patients experiencing poor mental health had a comprehensive care plan, which was above the CCG average of 87% and the 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • 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 make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held monthly multidisciplinary team meetings.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Patients who were carers were proactively identified and signposted to local carers’ groups. The practice engaged with the local Family Carers’ Prescription scheme, a local CCG initiative that gave access to the Peterborough branch of the Carers Trust who were able to provide information and support for carers.

  • 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. There was a lead member of staff for safeguarding.