What is the Quality of Facilities at Stillmoor House Medical Practice

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"At this inspection we looked at the arrangements for monitoring the temperature of refrigerators used to store medicines such as vaccinations."

Neutral

"The data from these was being downloaded and held on the practice computer system for further monitoring and audit by the practice manager."

Positive

"There was a good framework for the monitoring and improvement of health and safety with a proactive health and safety team led by the deputy practice manager."

Positive

"Management monitoring and improving outcomes for people The practice had a system in place for undertaking clinical audit cycles."

Positive

"Staff told us about the arrangements for planning and monitoring the number of staff and mix of staff needed to Are services safe?"

Positive

"There was no central log for monitoring purposes but decisions were entered into patient records."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Positive

"There was a good framework for the monitoring and improvement of health and safety with a proactive health and safety team led by the deputy practice manager."

Positive

"The practice also had a health and safety policy which was shared with staff during induction training."

Positive

"Health and safety information was displayed for staff to see and there was an identified health and safety representative."

Neutral

"It had raised funds for the practice buying for example a defibrillator a high backed chair and blood pressure monitors."

Positive

"It had a palliative care register and had regular internal as well as multidisciplinary meetings to discuss the care and support needs of patients and their families."

Positive

"The practice met fortnightly with the palliative care team including the Macmillan nurse and community nurse to discuss patients under their care."

Positive

"There was a fortnightly meeting with Macmillan nurses about palliative care."

Positive

"The practice worked as part of a multidisciplinary team for older patients comprising community nurses the practice nursing team Macmillan nurse and social worker to provide additional support ensure that medical care was coordinated and ensure patients were well cared for in the community."

Positive

"A nurse was given responsibility for the maintenance of personal protective equipment and the provision of personal cleaning supplies within clinical areas and a cleaner was responsible for the maintenance of the provision of personal cleaning supplies within nonclinical areas."

Positive

"GPs met regularly with the community mental health team CMHT psychiatrist and community psychiatric nurse CPN and counsellors to discuss patients for whom they shared care planning their care for the months ahead."

Positive

"The nurse practitioner identified postnatal mothers at risk of depression and informed the practice manager who made referrals as appropriate to an NHS service for people with emotional or psychological difficulties who want a talking treatment or for social support and domiciliary care."

Positive

"The nurse practitioner dealt with ‘on the day’ appointments dealing with minor injuries and illness mostly in children and elderly patients."

Positive

"The practice met fortnightly with the palliative care team including the Macmillan nurse and community nurse to discuss patients under their care."

Positive

"These appointments were with either a GP or practice nurse and offered counselling contraception lifestyle advice as well as routine medical care."

Positive

"These appointments were with a GP or practice nurse and offered counselling contraception lifestyle advice as well as routine medical care."

Positive

"The practice held a register for patients with learning disabilities and offered an annual extended appointment with an appropriately trained nurse to review their health and social care needs."

Positive

"The nurse lead worked closed with the community based learning disability nurse and visited housebound patients at their home address."

Positive

"There are also a nurse practitioner who was qualified as a prescriber three practice nurses and two healthcare assistants who provide nursing care."

Positive

"For example when a clinic was running late another nurse came to help out."

Positive

"For example the nurse practitioner met with the care coordinator and relatives at a care home where some patients were due a smear test."

Positive

"Health Promotion and prevention It was practice policy to offer a health check with the health care assistant practice nurse to all new patients registering with the practice."

Positive

"The practice nurse had made home visits and had got to know carers in care homes as well as family members."

Positive

"A practice nurse told us of an opportunity to volunteer to be a pilot practice for a local diabetes consultant to see patients at the practice."

Positive

"The nurse felt the practice culture was very much to encourage staff to continue learning and introduce new ways of working."

Positive

"• The local community team had instigated a ‘Single Point of Access’ for all referrals by patients with mental health problems including access to urgent care on the day using email to the duty community psychiatric nurse team for assessment."

Positive

"The local community team had instigated a ‘Single Point of Access’ for all referrals of patients with mental health problems including access to urgent care on the day using email to the duty community psychiatric nurse team for assessment."

Positive

"GPs and staff reported significant events and told us if they were about nursing issues they were discussed at the monthly nurse team meetings."

Positive

"We met with the lead practice nurse for diabetes who described clearly and accurately to us what changes to management and treatment could be implemented for a patient on the day of this visit."

Positive

"The practice manager had recently asked the lead nurse to check the nurses’ registrations with the Nursing and Midwifery Council and confirmed this had been done but there was no system for checking again at renewal date."

Neutral

"• Maintain a record of checks made when employing locum staff and maintain ongoing records of GP validations nurse registration and staff training."

Neutral

"Monthly clinics were held with the diabetic nurse specialist to discuss complex patients."

Neutral

"The practice nurse updated their training regularly with new guidance and was up to date with new medicines."

Neutral

"The nurse practitioner was also qualified as a prescriber: they carried out medicines reviews for example for patients with asthma or COPD and brought any concerns such as the patient’s polypharmacy to discuss with the GP."

Neutral

"A nurse did follow ups to monitor for any deterioration including in low mood or memory and would advise the patient to see the GP if there were concerns."

Neutral

"The lead nurse liaised with the duty GP at the practice if advice or additional treatment was required."

Neutral

"A nurse was always present during minor operations and IUCD coil fittings."

Neutral

"Extended hours were offered on alternate Wednesday and Thursday evenings and Saturday mornings with a nurse and a duty GP."

Neutral

"One nurse clinic room was on the first floor."

Neutral

"A new nurse had been appointed and was being funded for the nurse practitioner course."

Positive

"The telephone system allowed patients to leave a message for repeat prescription orders thus freeing up receptionist time and also allowing patients to order their medication at any time during the day."

Neutral

"If a homeless person arrived needing medical care the receptionist registered them as a temporary resident and contacted the duty GP."

Positive

"Following each clinical audit changes to treatment or care were made where needed and the audit repeated to ensure outcomes for patients had improved."

Positive

"Following each clinical audit changes to treatment or care were made for example audits of minor surgery had been carried out annually."

Positive

"Management monitoring and improving outcomes for people The practice had a system in place for undertaking clinical audit cycles."

Neutral

"The practice had a system in place for completing clinical audit cycles."

Positive

"A nurse was given responsibility for the maintenance of personal protective equipment and the provision of personal cleaning supplies within clinical areas and a cleaner was responsible for the maintenance of the provision of personal cleaning supplies within nonclinical areas."

Neutral

"Staff told us they had wipes for cleaning the chairs and the trolley desk and computer."

Positive

"The nurse practitioner dealt with ‘on the day’ appointments dealing with minor injuries and illness mostly in children and elderly patients."

Positive

"We were shown a shared care protocol stating that patients were not prescribed the medicine until the results of the blood test had been seen by the duty GP who then authorised the next repeat prescription."

Positive

"Action the service SHOULD take to improve • Review the policy and procedures for updating patients medicine records after discharge from hospital and for repeat prescribing."

Positive

"Medicines management We checked medicines stored in the treatment rooms and medicine refrigerators and found they were stored securely and were only accessible to authorised staff."

Positive

"Two of the three medicine fridges did not record maximum and minimum temperatures and although staff had recorded regular intermittent temperature checks they could not be sure that a constant safe temperature had been maintained."

Neutral

"In addition the provider should: • Review the policy and procedures for updating patients medicine records after discharge from hospital and for repeat prescribing."

Neutral

"We saw a log of the previous year’s SEAs in preparation for this inspection which enabled identification of a trend relating to medicine management."

Neutral

"Staff found the patient’s medicine record on the computer and sent it to the GP to sign on screen then it went to the pharmacy of the patient’s choice."

Neutral

"When informed by a consultant of a prescription of a new medicine for a patient they highlighted to the GP that a change was indicated."