Pudding Pie Lane Surgery

Updated 23 August 2018

Mendip Vale Medical Practice, the registered main service is located in a residential area of Langford, North Somerset. Mendip Vale Medical Practice also provides full time services from three other locations and part time services from one location. Together the locations had approximately 26,054 patients registered from around the local and surrounding mainly rural areas including Blagdon, Churchill, Claversham , Cleeve, Congresbury, Hewish Kenn, Kensington Seymour, Langford, St Georges, Wrington and Yatton. Mendip Vale Medical Practice is the result of several local GP services contracts being taken over by one provider in October 2015 and October 2016.

The addresses from where services are provided and where we visited during this inspection are:

Mendip Vale Medical (Langford)

Pudding Pie Lane

Langford

BS40 5EL

Mendip Vale Medical (Yatton)

155 Mendip Road

Yatton

BS49 4ER

Mendip Vale Medical (Congresbury)

Station Road

Congresbury

BS49 5DX

Mendip Vale Medical Practice (St Georges)

135 Pastures Avenue

St Georges

Weston Super Mare

BS22 7SB

The address from where part time (as and when demand requires) services are provided is:

Mendip Vale Medical (Wrington)

2 Broad Street

Wrington

BS40 5NG

We did not visit the Wrington site on this inspection.

Two of the five Mendip Vale Medical Practices buildings, at Pudding Pie Lane and St Georges, were purpose built in 2012/2013. The practice’s buildings at Yatton and Congresbury are converted residential buildings with limited car parking. The Mendip Vale Medical Practice at Wrington, a part time service, is held in a former retail store with no car parking.

Patients can attend any of the practice locations and there is a dispensary at Pudding Pie Lane. The practice can provide pharmaceutical services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy premises.

The practice is a partnership of eight GP partners who employ 20 salaried GPs. Ten of the GPs are male and 18 are female. Not all of the GPs work across all locations. The practice supports medical students and GP trainees from the Severn Deanery. At the time of this inspection, there were two foundation and one GP trainees at the practice. The practice employed five advanced nurse practitioners (ANPs) who were also independent prescribers, ten practice nurses and ten health care assistants. There was also one research nurse based at Pudding Pie Lane. The practice has an executive manager who is also the CQC registered manager, and is supported by a team of management staff, reception staff, administrators and secretaries.

The practice has a General Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice). The practice is contracted to deliver a number of enhanced services including; extended hours access for patients, childhood immunisations, enhanced services for the assessment and provision of services for patients living with dementia and the practice were involved in the unplanned hospital admission avoidance scheme. The practice is registered to provide the regulated activities of Diagnostic and screening procedures, Family Planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

The practice does not provide out of hour’s services to its patients, this is provided by BrisDoc. Contact information for this service is available in the practice and on the practice website.

According to information from Public Health England the practice area population is in the tenth least deprived decile in England. The practice population of children was similar to local and national averages. The practice population of working age (51%) is lower than local (59%) and national (62%)averages. The practice population of older people 65 years and above are similar to local and national averages. Of patients registered with the practice, 98% are White or White British, 0.7% are Asian or Asian British, 0.2% are Black or Black British, 0.9% are mixed British and 0.1% are Other.

Updated 23 August 2018

This practice is rated as Good overall. (Previous published rating October 2017 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Mendip Vale Medical Practice on 26, 27 and 28 June 2018. This inspection was to follow up the concerns we found at the previous inspection in August 2017. These areas of concern were relating to ensuring that appropriate disclosure and barring checks and training was in place for staff providing chaperone duties and there was proper and safe management of medicines including controlled medicines and prescription paper and pads. Also, the provider must have ensured that staff worked in accordance to the organisations policies and procedures in relation to significant event analysis, emergency medicines, complaints, medicines management and health and safety. In addition, the provider should have continued with the changes they were implementing for infection prevention, the immunisation status of staff, Control of Substances Hazardous to Health(COSHH), fire drills and checks on emergency equipment were sustained. Also, non-clinical staff responsible for telephone handling have the necessary training and guidance for the triage of patient's needs regarding the urgency of being seen by a clinician. The provider should have continued to notify the commission without delay any incidents of serious injury to a service user or events that may stop the service.

These concerns resulted in the practice being rated Requires Improvement overall, with the domains of Safe as Requires Improvement, Effective, Caring and Responsive as Good and Well Led as Inadequate.

At this inspection we found:

That the practice had responded and implemented a programme of improvement and the concerns previously found had been rectified.

We found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easier to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• The provider should develop its systems of checks and recording information regarding staff vaccinations in accordance to Public Health England (PHE) guidance.
• The practice should strengthen their risk assessment processes for infection prevention and control regarding identified risks and the actions taken to mitigate risks.
• The practice should review the safety and security of the external storage of their clinical waste.
• The practice should review information available to patients regarding chaperone service and processes for offering a chaperone.
• The practice should continue with monitoring and respond accordingly to patient feedback in regard to the concerns about the difficulty in making an appointment and access to appointments.
• The practice should improve how it keeps patients informed about any delays in waiting for appointments.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 23 August 2018

Updated 23 August 2018

Updated 23 August 2018

Updated 23 August 2018

Updated 23 August 2018

Updated 23 August 2018