Latest Snippet(s)
Positive
"The clinical team comprises of GPs advanced nurse practitioners practice nurses and a health care assistant."
Neutral
"In addition to the local team there is a regional team comprising of a business manager regional medical director a HR business partner and a nurse manager."
2018-09-13 Snippet(s)
Positive
"• There was a regional medical director and regional nurse manager who had assisted the practice in gaining new staff and supported those already working at the practice."
Positive
"We saw this role was well supported by practice staff and the regional nurse manager."
Positive
"• Patients were referred to community teams and nurse specialists including the heart failure and pulmonary rehabilitation teams."
Positive
"• Two advanced nurse practitioners."
Positive
"• Designated nonclinical staff coordinated these annual reviews overseen by the practice manager and an advanced nurse practitioner; they arranged prereview tests and offered flexibility with appointments to accommodate work and personal commitments."
Positive
"• An advanced nurse practitioner working at the practice specialised in mental health."
Positive
"Two advanced nurse practitioners had their sessions allocated for on the day appointments in addition to some GP appointments as well as a more staggered release of appointments."
Neutral
"The team included a GP specialist advisor a practice nurse specialist advisor and a second CQC inspector."
Neutral
"In addition to the local team there is a regional team comprising of a business manager regional medical director a HR business partner and a nurse manager."
Neutral
"The regional nurse manager had delivered training to reception and administrative staff on common signs and symptoms of patients who had or might present with sepsis."
Neutral
"• The practice nurse and advanced nurse practitioner managed chronic disease visits to housebound patients including flu vaccinations when appropriate who were not part of the community matron caseload."
Neutral
"For example a trainee practice nurse was undertaking training within the practice and on relevant courses to become the practices second practice nurse."
Neutral
"The GP phlebotomist and nurse also accommodated home visits for those who had difficulties getting to the practice."
Neutral
"The specialist diabetes nurse attended the practice to assist with the management of more complex patients."
2018-02-06 Snippet(s)
Positive
"• The practice had lost two recently recruited advanced nurse practitioners ANPs and there was a reliance on locum cover whilst recruitment was undertaken to cover this shortfall."
Positive
"• The practice was not always responsive to the needs of older people and although they offered home visits and urgent appointments for those with enhanced needs which included nurse appointments and flu vaccinations."
Neutral
"The team included a GP specialist advisor a practice manager specialist advisor a practice nurse specialist advisor a second CQC inspector and an expert by experience."
Neutral
"A nurse was the lead for infection control within the practice."
Neutral
"Staff who administered vaccines could demonstrate how they stayed up to date with changes to the immunisation programmes for example by access to on line resources and discussion at practice nurse meetings."
Neutral
"A review of the appointments system during the inspection demonstrated that there was a pre bookable appointment available with a GP in four days’ time and a practice nurse appointment in nine days’ time."
2017-03-30 Snippet(s)
Positive
"• As a success of the children’s walkin sessions and the addition of a further advanced nurse practitioner the practice were to begin adult walkin sessions each day to further increase capacity and flexibility in appointments reducing the need to call the practice for an appointment."
Positive
"For example the development of a paediatric walkin clinic was developed by an advanced nurse practitioner and led to implementation following a successful trial."
Positive
"We discussed all the data relating to ‘caring’ with the practice and to improve patient satisfaction they had introduced two walkin clinics paediatric and adult and also employed two advanced nurse practitioners and a practice nurse since our last inspection."
Positive
"• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs which included nurse appointments and flu vaccinations."
Positive
"An advanced nurse practitioner was the lead for infection control within the practice."
Positive
"However we found at the branch site there were regular gaps in the recording of fridge temperatures when the nurse was not working on particular days which did not ensure early identification of excessive changes to the temperatures and prompt further investigation."
Positive
"A review of the appointments system during the inspection demonstrated that there was a pre bookable appointment available with a GP in seven days’ time an advanced nurse practitioner in six days however the children’s walkin clinic was also available daily and a practice nurse appointment the following day."
Neutral
"Staff who administered vaccines could demonstrate how they stayed up to date with changes to the immunisation programmes for example by access to on line resources and discussion at practice nurse meetings."
2016-08-18 Snippet(s)
Positive
"The practice acknowledged improvements could be made and staff had taken proactive steps to liaise with the learning disability primary care liaison nurse and care home provider to improve these patients’ access to annual health checks and reviews."
Positive
"The practice was in liaison with the learning disability primary care liaison nurse and care home provider to ensure most of these patients received their health checks."
Positive
"• A pharmacist • An advanced nurse practitioner practice nurse a health care assistant and a phlebotomist."
Positive
"This included a pharmacist the ANP practice nurse phlebotomist health care assistant and a clinical administrator."
Positive
"This included district nurses the community matron palliative care nurse community specialist nurses and social services."
Positive
"The practice had addressed their immediate challenge of GP shortages and access issues by engaging five regular locum GPs and recruiting to post a pharmacist and an advanced nurse practitioner."
Positive
"This included a pharmacist and an advanced nurse practitioner."
Positive
"• All children under the age of five were seen on the day if necessary and plans were in place for the advanced nurse practitioner to facilitate walk in clinics for children with minor illnesses after our inspection."
Positive
"During our visit we: • Spoke with a range of staff including: the practice manager receptionadministrative staff GPs an advanced nurse practitioner practice nurses a healthcare assistant and phlebotomist."
Positive
"The practice had appointed the advanced nurse practitioner ANP as the infection control lead."
Neutral
"• The local specialist diabetic nurse attended the surgery on a regular basis for management of patients with complex needs."
Neutral
"This included specialist staff such as a pharmacist and an advance nurse practitioner ANP."
Neutral
"• The practice hosted an acupuncture service and the local diabetes specialist nurse facilitated a clinic each week to see patients with complex needs."
Latest Snippet(s)
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."
2018-09-13 Snippet(s)
Positive
"• Staff encouraged and supported patients to be involved in monitoring and managing their own health."
Positive
"There was oversight for planning and monitoring the number and mix of staff needed to meet patients’ needs including planning for holidays sickness and busy periods."
Positive
"• There was a monitoring process for patients prescribed high risk medicines."
Positive
"• The practice utilised the CCG funded care coordinator monitoring these patients for referral and management on an ongoing basis."
Positive
"However there was a new system of performance monitoring and oversight in place and additional clinicians had the specialist training to review patients with long term conditions."
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
"We saw a strategic approach to managing the transition and monitoring the changes made."
2018-02-06 Snippet(s)
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 evidence presented to us on the day indicated that the measures they had put in place had improved the monitoring of their patients with longterm conditions and mental health."
Positive
"The second audit showed there were no patients on repeat prescriptions for methotrexate and regular monitoring prior to prescription had been put in place."
Positive
"• The provider did not have sufficient monitoring in place to ensure consumable items were in date at the branch site."
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 was a lack of effective systems and processes in place for assessing and monitoring risks and the quality of the service provision."
2017-03-30 Snippet(s)
Positive
"• Additional staff had been recruited to improve the care provided to patients with long term conditions and roles realigned to ensure effective monitoring of conditions and individual responsibility for engaging with patients."
Positive
"However there were some areas the provider should make improvement: • Ensure the regular daily monitoring and recording of fridge temperatures at the branch surgery to allow for safe storage of vaccinations."
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
"This was underpinned by clear business development plans and regular monitoring of areas for improvement and development."
Positive
"The evidence presented to us on the day indicated that the measures they had put in place had improved the monitoring of their patients with long term conditions and mental health."
Positive
"This allowed oversight of governance arrangements within the practice however we found there was less oversight of the branch site which had caused lapses in temperature monitoring and stock management."
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
"• The monitoring of fridges used for the storage of medicines and the checking of out of date dressings required strengthening but this did not create a risk to patients."
2016-08-18 Snippet(s)
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
"Monitoring risks to patients The practice had procedures in place for monitoring and managing risks to patient and staff safety."
Positive
"Other services offered included: • Chronic disease management use of Florence telehealth service for monitoring blood pressure readings and phlebotomy."
Positive
"• Patients had access to “Florence” a telehealth system which allows for the monitoring of blood pressure readings at home at work or at the 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
"Arrangements were in place for Legionella testing; and this included monthly monitoring of the water systems by an external company."
Neutral
"The practice used a rota system for planning and monitoring the number and skill mix of staff to meet patients’ needs."
Latest Snippet(s)
Positive
"The previous reports can be found on our website at The Practice St Albans is registered with the CQC to carry out the following regulated activities diagnostic and screening procedures family planning surgical procedures maternity and midwifery services and treatment of disease disorder or injury."
2018-09-13 Snippet(s)
Positive
"• Practice leaders had established the providers’ policies procedures and activities to ensure safety and assured themselves they were operating as intended."
Latest Snippet(s)
Positive
"We rated the practice as requires improvement for providing safe services because: • The provider could not demonstrate effective review of the prescribing practice of nonmedical prescribers through clinical supervision audit or peer review."
2018-09-13 Snippet(s)
Positive
"• We were told that clinical supervision and support for revalidation was available."
2018-02-06 Snippet(s)
Positive
"This included ongoing support from regional managers meetings coaching and mentoring clinical supervision and facilitation and support for revalidating GPs and nurses."
2017-03-30 Snippet(s)
Positive
"This included ongoing support from regional managers meetings coaching and mentoring clinical supervision and facilitation and support for revalidating GPs and nurses."
2018-09-13 Snippet(s)
Positive
"• Regular meetings were held to review those patients requiring palliative care or approaching end of life."
2018-02-06 Snippet(s)
Positive
"In addition the practice held regular meetings to discuss patients on their palliative care register."
Positive
"These included palliative care meetings safeguarding children and adult meetings which were attended by all leads."
2017-03-30 Snippet(s)
Positive
"In addition the practice held regular meetings to discuss patients on their palliative care register."
Positive
"These included palliative care meetings and safeguarding children and adult meetings which were attended by all leads."
2016-08-18 Snippet(s)
Positive
"This included district nurses the community matron palliative care nurse community specialist nurses and social services."
2018-09-13 Snippet(s)
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."
2018-02-06 Snippet(s)
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."
2017-03-30 Snippet(s)
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."
2016-08-18 Snippet(s)
Neutral
"For example: • Patients receiving end of life care those at risk of developing a longterm condition and those requiring advice on their diet smoking and alcohol cessation."
2018-09-13 Snippet(s)
Positive
"• The managerial arrangements within the practice were aligned with those of the provider and there was support in key areas such as HR clinical governance and legal from a central team as needed."
2017-03-30 Snippet(s)
Positive
"This included the arrangements for clinical governance and performance management which did not always operate effectively."
2016-08-18 Snippet(s)
Positive
"• The arrangements for clinical governance and performance did not always operate effectively and some incidents notifiable to the Care Quality Commission had not been reported as required by law."
Positive
"For example the arrangements for clinical governance and performance did not always operate effectively and some incidents notifiable to the Care Quality Commission had not been reported as required by law."
Positive
"For example • the systems for clinical governance and performance did not always operate effectively and as a result some clinical outcomes were lower than the local and national averages."
2018-09-13 Snippet(s)
Neutral
"For example we saw evidence of a clinical audit programme."
2017-03-30 Snippet(s)
Neutral
"• There was an ongoing programme of clinical audit within the practice."
2018-09-13 Snippet(s)
Positive
"• Staff were clear on their roles and accountabilities including in respect of safeguarding and infection prevention and control however the lead roles were not always known by staff."
2018-02-06 Snippet(s)
Positive
"• Ensure infection prevention and control procedures to ensure improvement in the cleanliness and hygiene at the branch site in line with national guidance."
2018-09-13 Snippet(s)
Positive
"The pharmacist involved patients in regular reviews of their medicines and would support clinicians in selecting the most appropriate medicine if required."
Positive
"• The practice acted appropriately on patient and medicine safety alerts."
2018-02-06 Snippet(s)
Positive
"• The practice in conjunction with the pharmacist carried out regular medicine reviews including highrisk medicines to ensure prescribing was in line with best practice guidelines for safe prescribing."
Positive
"• A pharmacist reviewed patients prescribed high risk medicines and undertook medicine reviews."
2017-03-30 Snippet(s)
Positive
"For example the practice audited the care patients on methotrexate a medicine which can be used to prevent joint damage in patients with arthritis to ensure they were not automatically prescribed the medicine in the long term without relevant monitoring."
2016-08-18 Snippet(s)
Positive
"An outcome from this project included recruiting a pharmacist who supported the GPs in dealing with medicine queries and reviews; as well as reviewing the prescribing of medicines."
Neutral
"• Telephone consultations were offered by a “remote GP” GP working from home for test and scan results medicine reviews and providing general medical advice."
Neutral
"• The scope of their work included dealing with test results providing general medical advice medicine reviews and the reviews of people with long term conditions who don’t require a face to face appointment."
Neutral
"A recent audit demonstrated the majority of appointments were being utilised for blood results medicine reviews and scan results."
2017-03-30 Snippet(s)
Positive
"The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening and screening rates were comparable to local and national averages."
2016-08-18 Snippet(s)
Positive
"This included NHS health checks and cancer screening programmes."
2018-02-06 Snippet(s)
Positive
"• There were facilities for patients with a disability including dedicated parking and accessible toilets."
2017-03-30 Snippet(s)
Positive
"• There were facilities for patients with a disability including dedicated parking and accessible toilets."
2018-02-06 Snippet(s)
Neutral
"These covered areas such health and safety IT fire safety infection control and confidentiality."
2017-03-30 Snippet(s)
Neutral
"These covered areas such health and safety IT fire safety infection control and confidentiality."
2016-08-18 Snippet(s)
Positive
"Staff were also provided with a health and safety handbook which included information on fire safety manual handling and accidents."
Positive
"This included undertaking appropriate recruitment checks health and safety risk assessments and having procedures in place for dealing with medical emergencies."
Positive
"This included a health and safety policy and service agreements that allowed for periodic review of equipment."