Latest Snippet(s)
Positive
"At the time of the previous inspection the uptake for the practice’s patients for breast and bowel cancer screening was below the local and national average."
Latest Snippet(s)
Positive
"We also found that the practice had failed to assess the competence of nurse prescribers that some staff were unclear about the relevant consent and decisionmaking requirements of legislation and guidance and that the practice had failed to address the belowaverage uptake by patients of national screening programmes."
Positive
"• During the previous inspection we found that the practice had failed to complete an assessment of competence to assure themselves that their nurse prescribers had the skills and knowledge to perform their role in diagnosing and prescribing for patients presenting with any acute condition."
Positive
"We reviewed the qualifications of one of the nurse practitioners and found that they had Are services effective?"
Positive
"Following the inspection the practice had completed a risk assessment of the role of nurse prescribers and had used this as a basis to develop a competency framework for these staff members."
Positive
"The practice had encountered difficulties in recruiting a practice nurse which was reflective of the national shortage of practice nurses."
Neutral
"• The practice had introduced a comprehensive risk assessment and competency framework for nurse prescribers."
Neutral
"When we reinspected we found that the practice had recruited a new nurse who was being trained in practice nursing having had a background in another specialism."
Neutral
"The practice also employs one part time female nurse practitioner who provides a total of one clinical session and one administrative session per week and one part time female nurse."
Neutral
"We found that the practice had nursing staff who had qualified as independent nurse prescribers which allowed them to prescribe any medication within the scope of their competence."
Neutral
"In order to address this they had recruited a nurse from a different specialty and had invested in training them to qualify as a practice nurse."
2017-04-26 Snippet(s)
Positive
"The nurse practitioners had completed training in diabetes care contraception and travel health and attended regular update training."
Positive
"We reviewed the qualifications of one of the nurse practitioners and found that they had completed specific training in diabetes care contraception and travel health."
Positive
"The practice had no formal process to review consultations carriedout by nurse practitioners; we were told that discussions about competence and performance would be undertaken where there were concerns about an individual’s practice."
Positive
"We were also told that patient notes were reviewed ahead of nurse practitioners’ annual appraisals; however from the notes of appraisals that the practice showed us we saw no evidence of clinical competence being discussed."
Neutral
"We were informed that nurse practitioners would not see children under two years for general consultations of acute conditions but saw evidence that they did."
Neutral
"The practice also employs two part time female nurse practitioners who provide a total of three clinical sessions per week one part time female nurse who is being trained in general practice having been recently recruited from a different clinical field and one healthcare assistant."
Neutral
"One of the nurse practitioners was the infection control clinical lead; however she was not up to date with infection control training."
Neutral
"• The nurse practitioners had qualified as independent nurse prescribers which allowed them to prescribe any medication within the scope of their competence."
Neutral
"The practice explained that they were in the process of training a new practice nurse and recruiting a further nurse and that they felt that increasing the nursing provision in the practice would address the issue."
2015-02-19 Snippet(s)
Positive
"They had reviewed prescribing as per the medicines management programme a national initiative aimed at promoting safe effective and cost effective prescribing and this was shared with clinical staff by email as the senior nurse circulated the audit results and described best practice."
Positive
"We received one negative response from a patient who told us they had received very little diabetic follow up as they had not seen the diabetic nurse for over two years however no other negative comments re diabetic care were received."
Positive
"During our visit we spoke with a range of staff including three GPs two of whom were partners the assistant practice manager the practice nurse nurse practitioner health care assistant and reception and administrative staff."
Positive
"Complaints were dealt with by the nurse practitioner andor the business and operations manager and elevated to the senior partner if necessary."
Positive
"The nurse practitioner felt that this was not a true reflection of the number of patients with dementia and said it was an area that they needed to focus on going forward."
Positive
"Complaints were logged by the practice’s business manager and dealt with initially by the business manager or the nurse practitioner."
Positive
"We discussed the practice’s chronic disease registers with the nurse practitioner."
Neutral
"There are a further six sessions of clinical time provided by two female salaried GP s and three sessions per week by nurse practitionerprescribers."
Neutral
"There is currently a part time practice nurse who works one full day per week a part time healthcare assistant four mornings per week and one phlebotomist who works one morning per week."
Neutral
"Underfives and the elderly are prioritised for same day appointments either with a GP of with a nurse practitioner."
Neutral
"This included a nurse practitioner."
Neutral
"For example the practice had recently recruited two additional nurses and also had nurse practitioners already in post."
Neutral
"The nurse practitioner told us that they had recently employed an apprentice from a local scheme in Kingston to assist with an enhanced services project to reduce the number of unplanned hospital admissions."
Neutral
"We raised the issue of supervision and appraisal with the business manager the nurse practitioner and one of the GP partners."
Neutral
"One of the nurse practitioner’s had been trained to use this methodology."
Neutral
"Underfives and the elderly were prioritised for same day appointments either with a GP or with a nurse practitioner."
Latest Snippet(s)
Positive
"We identified breaches of regulations relating to staffing and the monitoring of safety and we issued requirement notices in relation to these breaches."
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."
2017-04-26 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
"We identified breaches of regulations relating to staffing and the monitoring of safety and we issued requirement notices in relation to these breaches."
Positive
"• There were procedures in place for monitoring and managing risks to patient and staff safety."
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 planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."
2015-02-19 Snippet(s)
Positive
"However improvements are needed with regard to staff recruitment and support; monitoring infection control; the processes for dealing with test results and the overall governance framework all of which can impact on the quality of patient care."
Positive
"However improvements were needed with regard to staff recruitment and support; monitoring infection control; the processes for dealing with test results and the overall governance framework all of which can impact on the quality of patient care."
Positive
"However improvements are needed with regard to staff recruitment and support; monitoring infection control; the processes for dealing with test results and the overall management oversight all of which can impact on the quality of patient care."
Positive
"Whilst these were discussed at clinical meetings there was no monitoring to ensure appropriate learning had taken place where necessary or that the findings were disseminated to all relevant staff."
Positive
"We saw the practice had a cleaning contract in place but that there was no monitoring of this to ensure that the cleaners carried out the work that was required to the standard desired."
Positive
"Management monitoring and improving outcomes for people The practice provided us with two examples of clinical audits they had carried out in relation to medication."
Positive
"We saw that any member of the administrative team could review and action this information with noone taking a lead role and no monitoring system in place to ensure that all tests and letters had been appropriately actioned."
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
"Staff told us about the arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."
Neutral
"For example one audit related to the prescribing of and monitoring of patients taking lithium."
Latest Snippet(s)
Positive
"The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease disorder or injury; surgical procedures; and family planning."
2017-04-26 Snippet(s)
Positive
"The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease disorder or injury; surgical procedures; and family planning."
2017-04-26 Snippet(s)
Neutral
"This covered such topics as safeguarding infection prevention and control fire safety health and safety and confidentiality."
Latest Snippet(s)
Positive
"• The IPC lead was trained for the role and the practice had put in place a log of highlevel cleaning undertaken by the cleaner; however the practice did not keep a log of the cleaning of small clinical equipment and machinery."
Neutral
"When we reinspected we found that a log of cleaning had been put in place and that the IPC lead was up to date with training; however the practice did not keep a log of the cleaning of small clinical equipment."
2017-04-26 Snippet(s)
Positive
"• Ensure that adequate processes are in place to manage the risks of infection including putting processes in place to monitor cleaning in the practice and ensuring that staff with specific infection control responsibilities are qualified to undertake their role."
Positive
"In addition the practice should: • Ensure that records are kept of the cleaning carriedout."
Neutral
"A cleaning schedule was in place for cleaners to follow; however cleaners did not complete a record of the cleaning they had carriedout."
2015-02-19 Snippet(s)
Positive
"We saw the practice had a cleaning contract in place but that there was no monitoring of this to ensure that the cleaners carried out the work that was required to the standard desired."
Latest Snippet(s)
Positive
"All the medicines we checked were in date; the practice had a record of expiry dates of emergency medicine and completed monthly checks of emergency medicines and equipment."
2017-04-26 Snippet(s)
Positive
"All the medicines we checked were in date; the practice had a record of expiry dates of emergency medicine and completed monthly visual checks of emergency medicines and equipment; however we saw no evidence of stocks of emergency medicines being regularly checked."
2015-02-19 Snippet(s)
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."
Neutral
"We saw the practice had completed audits including reauditing in relation to medicine management targets."
2017-04-26 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."
2017-04-26 Snippet(s)
Positive
"This included ongoing support onetoone meetings coaching and mentoring clinical supervision and facilitation and support for revalidating GPs and nurses."
2017-04-26 Snippet(s)
Positive
"There was a health and safety policy available with a poster which identified local health and safety representatives."
Neutral
"This covered such topics as safeguarding infection prevention and control fire safety health and safety and confidentiality."
2015-02-19 Snippet(s)
Positive
"The practice also had a health and safety policy."
2015-02-19 Snippet(s)
Positive
"A specific form was used if the local hospice or palliative care team were involved."
Positive
"The practice had a palliative care register and worked closely with community matron district nurses and health visitors."
Neutral
"Staff used a specific reporting form for their palliative careend of life patients so that the out of hours provider was fully briefed."
2015-02-19 Snippet(s)
Positive
"Initially staff were not sure if they did provide that service but were later able to provide an information leaflet downloaded from the internet which outlined the translation service provided by the local authority which the practice had not had cause to use to date."
2015-02-19 Snippet(s)
Neutral
"Underfives and the elderly are prioritised for same day appointments either with a GP of with a nurse practitioner."
Neutral
"Underfives and the elderly were prioritised for same day appointments either with a GP or with a nurse practitioner."