What is the Quality of Facilities at The Thorndike Surgery

Neutral

"• There were routine and on the day appointments available on the day of the inspection with the practice nurse and the following day with a GP."

Neutral

"However staff told us that they were employing additional locum GPs directly and via an agency as well as training one of their healthcare assistants to be a practice nurse and one of their phlebotomists to be a healthcare assistant."

Positive

"For example the practice had increased the number of contraception clinics and patients requesting the mini pill method of contraception were to be seen by a nurse or healthcare assistant to help ensure correct information was given."

Positive

"The practice had been successful in directly employing two locum GPs for some sessions but an advanced nurse practitioner had recently left and a practice nurse was due to leave in the near future."

Neutral

"During our visit we: • Spoke with a range of staff one GP partner one salaried GP one GP Registrar the clinical nurse manager three practice nurses the practice manager the office manager one receptionist and three secretaries and spoke with patients who used the service."

Positive

"For example nurse managed home visits and nurses andor paramedics managing day to day walk in and emergency clinics as well as chronic disease management clinics."

Positive

"There were also appropriate arrangements to enable the nurse to administer medicines that had been prescribed and dispensed for patients."

Positive

"Management monitoring and improving outcomes for people The GPs clinical nurse manager and administrative staff told us that registers were kept to identify patients with specific conditionsdiagnoses."

Positive

"The GPs and clinical nurse manager told us that they liaised regularly with social services to share information in relation to adult and child protection concerns that were identified within the practice."

Neutral

"The team included a GP specialist advisor a practice nurse specialist advisor and an Expert by Experience."

Neutral

"During our visit we spoke with a range of staff including four GPs the clinical nurse manager three practice nurses four administration staff the office manager the management consultant and the vice chair of the patient participation group PPG."

Neutral

"We saw that these issues were reported to either of the partner GPs or the clinical nurse manager who created a report that was subsequently discussed by the staff team."

Neutral

"All new patients who registered with the practice were offered a consultation with the nurse to assess their health care needs and identify any concerns or risk factors that would then be referred to the GPs."

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

"Records showed that the plan contained time frames for action points as well as monitoring of the practice’s progress in addressing the identified issues."

Positive

"Responsibility for monitoring and recording the temperature of medicine refrigerators was rostered to individual staff members."

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 risk assessment report contained recommendations for action to be taken to reduce the risk of legionella and ongoing monitoring of the water system in the building."

Positive

"With the exception of those recorded in the risk assessment the practice was unable to demonstrate any further monitoring and recording of water temperatures from hot or cold outlets had taken place."

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

"Staff told us that they had obtained a quotation from an external company to carry out the recommendations from the legionella risk assessment as well as set up monitoring of the water system in the building."

Positive

"• There were procedures 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

"There was written guidance available for staff on the monitoring of refrigerator temperatures."

Neutral

"• Staff told us about the arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."

Positive

"Both patients and staff were encouraged and supported to be actively involved in the quality and monitoring of services provided to help ensure improvements were made."

Positive

"The practice used QOF audit results for managing monitoring and improving outcomes for patients."

Positive

"Learning and improvement from safety incidents The practice had a system for reporting recording and monitoring significant events incidents and accidents."

Positive

"Management monitoring and improving outcomes for people The GPs clinical nurse manager and administrative staff told us that registers were kept to identify patients with specific conditionsdiagnoses."

Positive

"There were arrangements for monitoring safety using information from audits risk assessments and routine checks that were undertaken by staff."

Positive

"This included monitoring of complaints analysis and review of significant events."

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 staff we spoke with were able to describe their responsibilities in relation to monitoring reporting and recording incidents and concerns."

Neutral

"Staff told us about the arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."

Positive

"We also identified two areas where the provider should make improvements: • Continue to work with the contracted external cleaning company to manage and reduce the risks associated with legionella."

Neutral

"Cleaning schedules were used and completed by staff to identify and monitor the cleaning activities undertaken on a daily weekly and monthly basis."

Neutral

"During our visit we: • Spoke with a range of staff one GP partner one salaried GP one GP Registrar the clinical nurse manager three practice nurses the practice manager the office manager one receptionist and three secretaries and spoke with patients who used the service."

Positive

"These activities together with employment of locum GPs as well as developing existing members of staff had led to an improvement in availability of services provided by the practice."

Neutral

"Cleaning schedules were used and completed by staff to identify and monitor the cleaning activities undertaken on a daily weekly and monthly basis."

Positive

"For example health and safety risks the potential risk of legionella in the building’s water system and risks associated with the lack of an effective system that managed test results and other incoming correspondence."

Positive

"• Improvements to risk management had been made with health and safety risks now being assessed and well managed."

Positive

"• Improvements to risk management had been made and health and safety risks were now being assessed and well managed."

Positive

"Monitoring risks to patients • The practice had revised the action plan that had been developed to address issues identified by their health and safety compliance audit."

Positive

"For example health and safety risks the potential risk of legionella in the building’s water system and risks associated with the lack of an effective system that managed test results and other incoming correspondence."

Positive

"There was a health and safety policy available with a poster in the reception office which identified local health and safety representatives."

Positive

"Records showed that actions had been carried out to reduce some health and safety risks."

Positive

"The practice had completed risk assessments in relation to the premises such as fire risk assessments health and safety and security of the building external and internal."

Positive

"The practice had a health and safety policy."

Neutral

"There was an infection control protocol and staff had received up to date infection prevention and control training."

Positive

"They demonstrated a clear understanding of their role and responsibilities in relation to infection prevention and control including referring outbreaks of infectious diseases to external agencies."

Positive

"Records showed that vaccines stored in the practice’s medicine refrigerators were being stored at the recommended temperature."

Positive

"Responsibility for monitoring and recording the temperature of medicine refrigerators was rostered to individual staff members."

Neutral

"• All these patients were offered a structured annual review to check their health and medicine needs were being met."

Positive

"Medicines Management We spoke with GPs and administrative staff who told us there was a system for checking that repeat prescriptions were issued according to medicine review dates and helped ensure that patients on longterm medicines were reviewed on a regular basis."

Positive

"The electronic records system contained indicators to alert clinical staff to specific patient needs and any followup actions required for example medicine and treatment reviews."

Positive

"For example following an alert from the Medicines and Healthcare Products Regulatory Agency MHRA regarding a medicine used to manage diabetes a clinical audit was carried out."

Positive

"The aim of the audit was to ensure that all patients prescribed this medicine were not put at risk of being under or over dosed."

Neutral

"The temperature of the medicine refrigerator was monitored and documented."

Neutral

"We were shown records of medicine audits that had been carried out following the receipt of national guidelines and standards provided to the practice by NHS commissioners and other stakeholders."

Positive

"This included ongoing support onetoone meetings coaching and mentoring clinical supervision and facilitation and support for revalidating GPs."

Positive

"From minutes of meetings and our discussion with the vice chair of the PPG we observed that the PPG had recognised that the practice was going through a state of change and were supporting the practice by focussing on how to get messages about changes across to the patientspublic."

Neutral

"During our visit we spoke with a range of staff including four GPs the clinical nurse manager three practice nurses four administration staff the office manager the management consultant and the vice chair of the patient participation group PPG."

Positive

"These processes helped ensure that links with the palliative care team and district nurses for example remained effective and promoted patients care welfare and safety."

Positive

"GPs and nurses said that they attended quarterly meetings with the palliative care team to promote a united approach to patient care and treatments."

Positive

"Patients told us they did not experience problems when they required urgent or medical emergency appointments."

Positive

"There were ramps to gain entry into the practice and appropriate parking spaces close to the entrance door."

Neutral

"There was lift access to the first floor."

Positive

"There were systems to ensure patients received care and treatment that was appropriate to their condition based on findings of clinical audit cycles."

Positive

"For example following an alert from the Medicines and Healthcare Products Regulatory Agency MHRA regarding a medicine used to manage diabetes a clinical audit was carried out."