What is the Quality of Facilities at Prentis Medical Centre

Positive

"There is one female practice nurse who works one day per week a full time health care assistant and practice pharmacist who is in the practice every week day but does not work on Tuesday or Thursday afternoon."

Neutral

"• Review whether there is sufficient access to female GP appointments and nurse appointments."

Neutral

"The practice told us that the nurse had been known to the practice for a number of years and had previously been employed as locum."

Positive

"The healthcare assistant was competent to undertake some of the duties of the practice nurse and the locum nurse was able to fulfil all tasks outside of the healthcare assistant’s competence."

Positive

"The practice demonstrated efforts made to recruit a practice nurse but were finding this difficult."

Neutral

"The practice nurse had left since our last inspection and the practice had designated their newly appointed healthcare assistant as the lead in the interim."

Positive

"• Where a patient’s mental capacity to consent to care or treatment was unclear the GP or practice nurse assessed the patient’s capacity and recorded the outcome of the assessment."

Positive

"Not all staff had received training on safeguarding children and vulnerable adults including the practice nurse and one of the partners."

Positive

"However the practice nurse told us that they were unsure how to make a safeguarding referral and the practice’s safeguarding policies did not all contain information of external safeguarding contacts; though this was documented on posters around the practice."

Positive

"The practice nurse was the infection control clinical lead but there was no evidence that they had received up to date training for this role."

Neutral

"During our visit we: • Spoke with a range of staff GPs the practice nurse the practice manager and deputy practice manager and spoke with patients who used the service."

Positive

"In addition to formally documented audits the practice had systems for routine monitoring of the effectiveness of various aspects of care including of the ‘virtual clinics’ for diabetes respiratory conditions and mental health."

Positive

"• Staff encouraged and supported patients to be involved in monitoring and managing their health."

Positive

"For example after concerns were raised about a patient missing slow release medicine for a mental health condition the practice investigated the issue wrote a new protocol carried an audit and reviewed all relevant patients who were then added to a new monitoring system."

Positive

"• The practice monitored and reviewed activity this had led to safety improvements such as new monitoring systems."

Positive

"As a result we saw that the practice had created a specific protocol for this medicine and a monitoring system to ensure that the event could not recur."

Positive

"For example after a significant event arose relating to monitoring of medicines for mental health conditions the practice reviewed its systems for monitoring other medicines and introduced tighter systems for some other medicines that are considered high risk."

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

"• There were arrangements for planning and monitoring the number and mix of staff needed."

Positive

"However we identified areas where additional action needed to be taken: Management monitoring and improving outcomes for people The practice used the information collected for the Quality and Outcomes Framework QOF and performance against national screening programmes to monitor outcomes for patients."

Positive

"For the three patients who did not have an agreement in place there was evidence that the practice had repeatedly contacted the secondary care provider for clarification regarding who should be monitoring these patients."

Positive

"• Concerns around high risk drug monitoring had been addressed."

Positive

"The practice implemented a thorough review and monitoring system in response to the event to ensure that adequate indemnity arrangements are in place for all staff."

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

"Management monitoring and improving outcomes for people The practice used the information collected for the Quality and Outcomes Framework QOF and performance against national screening programmes to monitor outcomes for patients."

Positive

"• The arrangements in place for planning and monitoring the number of staff and mix were not sufficient to ensure patients were safe."

Positive

"However there was no failsafe monitoring system in place for patients who were referred for urgent test and assessments."

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

"• The facilities and premises were generally appropriate for the services delivered although there was no lift or other facility for patients who could not easily manage the stairs."

Positive

"• Practice leaders had established proper policies procedures and activities to ensure safety."

Positive

"The practice was involved in a pilot project to improve end of life care for patients in nursing homes by using a planning tool that has been demonstrated to improve end of life care for patients in hospitals."

Positive

"• The practice was involved in a pilot project to improve end of life care for patients in nursing homes by using a planning tool that has been demonstrated to improve end of life care for patients in hospitals."

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."

Neutral

"For example: • Patients receiving end of life care carers those at risk of developing a longterm condition and those requiring advice on their diet smoking and alcohol cessation."

Positive

"This included an induction process onetoone meetings appraisals clinical supervision and support for revalidation."

Positive

"• The assessment of the risk of and arrangements to preventing detecting and controlling the spread of infections including those that are health care associated were not comprehensive as specification for curtain cleaning was not documented."

Neutral

"We saw records that showed that these were washed regularly but the specification for this was not included in the cleaning schedule for the practice."

Positive

"Feedback we obtained from these homes previously was that practice staff were good at providing high quality personalised care and worked well with staff from other organisations to devise and implement appropriate packages of care for frail elderly patients."

Positive

"• The practice provided GP services to seven care homes which catered for frail elderly patients andor those with dementia."

Positive

"The practice provided feedback they had gathered from these homes prior to our inspection which stated that practice staff were good at providing high quality personalised care and worked well with staff from other organisations to devise and implement appropriate packages of care for frail elderly patients."

Positive

"• The practice provided GP services to seven care homes which catered for frail elderly patients andor those with dementia."

Positive

"The PPG had also assisted the practice in hosting three “well in winter” evenings which were evenings targeted at the elderly population; providing advice on how to remain healthy during the winter months."

Positive

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

Positive

"Exception reporting is the removal of patients from QOF calculations where for example the patients decline or do not respond to invitations to attend a review of their condition or when a test or medicine is not appropriate."

Positive

"For example after concerns were raised about a patient missing slow release medicine for a mental health condition the practice investigated the issue wrote a new protocol carried an audit and reviewed all relevant patients who were then added to a new monitoring system."

Positive

"As a result we saw that the practice had created a specific protocol for this medicine and a monitoring system to ensure that the event could not recur."

Positive

"• The practice had a system in place to ensure that patients who received injections of slow release anti psychotic medicine received the doses at the required intervals following a significant event."

Positive

"The practice were aware that they were an outlier in this area and told us that clinical staff were working with the practice pharmacist to review patients with atrial fibrillation to ensure that patients were prescribed anticoagulation medicine where appropriate."

Neutral

"The practice pharmacist was able to prescribe for patients and complete medicine reviews."

Positive

"The practice told us that this was because the patient had been admitted to hospital but prescriptions for this medicine continued to be issued."

Neutral

"However we reviewed the records of one patient who required medicine to be reviewed every three months."

Positive

"The practice also provided us with two reflective case studies concerning the management of palliative care patients."

Positive

"The practice provided reflective case studies regarding the management of palliative care patients which evidenced multidisciplinary working and communication between the practice and these organisations."

Positive

"• We saw evidence that although some risks to patient safety had been considered and mitigating action had been taken there were some health and safety risks which had not been considered or where action had not been taken to address the risks identified."

Positive

"There was a health and safety policy available with a poster in the reception area."

Positive

"This covered such topics as safeguarding infection prevention and control health and safety and confidentiality."

Positive

"This covered such topics as safeguarding infection prevention and control health and safety and confidentiality."