What is the Quality of Facilities at Church Lane Surgery

Positive

"There is also a senior practice nurse two advanced nurse practitioners and a healthcare assistant who works at the practice."

Neutral

"The team included a GP specialist adviser a specialist nurse advisor and a second inspector."

Positive

"• The provider employs a number of locum GPs at the practice an advance nurse practitioner and a health care assistant."

Positive

"• The provider employs two GPs at the practice a practice nurse and a health care assistant."

Positive

"We based our judgement of the quality of care at this service on a combination of: • what we found when we inspected • information from our ongoing monitoring of data about services and • information from the provider patients the public and other organisations."

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

"We based our judgement of the quality of care at this service on a combination of: • what we found when we inspected • information from our ongoing monitoring of data about services and • information from the provider patients the public and other organisations."

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

"We based our judgement of the quality of care at this service on a combination of: • what we found when we inspected • information from our ongoing monitoring of data about services and • information from the provider patients the public and other organisations."

Positive

"• The practice had implemented a system for monitoring uncollected prescriptions to ensure they were monitored effectively."

Positive

"• The system for monitoring uncollected prescriptions was not effective."

Positive

"Overall we found that the practice had complied with the warning notice however further improvements were required to improve the monitoring of patients with health conditions that were subject to the Quality and Outcomes Framework."

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

"Not all patients were receiving annual monitoring in a timely manner."

Positive

"• The system for monitoring uncollected prescriptions was not effective."

Positive

"There were some arrangements for planning and monitoring the number and mix of staff needed to meet patients’ needs including planning for holidays sickness busy periods and epidemics."

Positive

"People with suspected hypertension were offered ambulatory blood pressure monitoring and patients with atrial fibrillation were assessed for stroke risk and treated as appropriate."

Positive

"There was a system to manage the monitoring of fridge temperatures however if the member of staff that had responsibility was absent from work monitoring was not completed in a timely manner."

Positive

"However although we found that fridge temperatures were generally well monitored when the member of staff who had the responsibility for measuring temperatures was away from work temperature monitoring was not completed on a daily basis."

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

"Not all patients were receiving annual monitoring in a timely manner."

Positive

"• Leaders had established policies procedures and activities to ensure safety however could not assure themselves that they were operating as intended."

Positive

"• There was some evidence of clinical audit however this was limited and was not used as a tool to drive improvements in the practice."

Positive

"• There was some evidence of clinical audit however this was limited and was not used as a tool to drive improvements in the practice."

Positive

"There was some evidence of clinical audit however this was limited and was not used as a tool to drive improvements in the practice."

Neutral

"• We saw there had been one cycle of a clinical audit relating to the use of sodium valproate in women of child bearing age."

Positive

"The practice had contact with the local palliative care team to discuss preferred place of care and end of life decisions."

Positive

"• The practice’s uptake for breast and bowel cancer screening was generally in line with the national average."

Neutral

"• We saw clinicians had access to the internet for access to guidance and kept themselves up to date with guidance."

Neutral

"• The practice ensured that end of life care was delivered in a coordinated way which took into account the needs of different patients including those who may be vulnerable because of their circumstances."

Positive

"• There was a lack of focus on the clinical leadership and governance systems."

Positive

"There was no health and safety risk assessment completed on the day of inspection for the building this was completed after the inspection."

Positive

"However there was no health and safety risk assessment available on the day of inspection."

Positive

"• On the day of inspection the practice had not undertaken a health and safety risk assessment."

Positive

"• The practice had not undertaken a health and safety risk assessment."

Positive

"• The practice acted on and learned from external safety events as well as patient and medicine safety alerts."