What is the Quality of Facilities at Orchard Surgery - St Ives

Positive

"There are three GP partners two male and one female and the practice employs two salaried GPs both female two advance nurse practitioners four practice nurses and a number of health care assistants several administration staff and dispensary staff."

Positive

"There are four GP partners two male and two female and the practice employed three GPs two female and one male two advance nurse practitioners female and three practice nurses and health care assistants and several administration staff and dispensary staff."

Neutral

"The team included a GP specialist advisor a practice nurse specialist advisor and a practice nurse specialist advisor who was shadowing the team."

Positive

"Nursing staff told us that they had found this supportive and were looking forward to the new opportunities of nurse lead clinics for the management of long term conditions."

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

"• A community diabetes nurse attended the practice monthly to help patients living with diabetes."

Positive

"The practice nurse was named as the infection prevention and control IPC clinical lead and had received training and support from the lead nurse for IPC from within the local clinical commissioning group CCG."

Positive

"The nurse had supported the practice with completing an audit and identity improvements needed."

Positive

"At the end of their investigation the nurse was assured that there was no issue."

Neutral

"• Patients told us they could always make an appointment with a GP or nurse both in advance and on the same day."

Neutral

"This staff member held a dispensary qualification was a registered nurse and held a qualification to support patient who may be experiencing mental health problems."

Positive

"• The lead member of staff for infection control in the practice was a nurse who had attended appropriate training to undertake this role."

Neutral

"The practice had liaised with the local infection control nurse who undertook a joint audit of the practice."

Neutral

"The practice nurse had liaised with the local infection control nurse who had attended the practice and undertaken a joint infection control audit."

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

"• A community diabetes nurse attended the practice monthly to help patients living with diabetes."

Positive

"At the end of their investigation the nurse was assured that there was no issue."

Neutral

"We saw an example where a member of the practice nurse team investigated a situation which had given concerns relating to female genital mutation FGM."

Neutral

"The practice nurse was named as the infection control clinical lead but they had not received training for this role."

Neutral

"For example a diabetic specialist nurse clinic attended monthly for patients with diabetes who had complex needs."

Positive

"• We found the monitoring of patients in waiting areas was not effective."

Positive

"• We found the monitoring of prescription stationery was not always effective."

Positive

"We found that waiting areas at Parkhall and Orchard sites were a considerable distance from the reception area and the practice staff did not routinely monitor patients in the waiting area there was no system in place to ensure monitoring of these areas in the event of an emergency."

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

"In particular: • We found the monitoring of prescription stationery was not always effective."

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 practice had developed a system for providing oversight for the management of high risk medicines such as lithium warfarin methotrexate and other disease modifying drugs which included regular monitoring in accordance with national guidance."

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 ensured these medicines were dispensed only following appropriate monitoring tests."

Positive

"• The practice had implemented a practice based recall system to ensure patients that required regular monitoring were contacted for annual reviews."

Positive

"Monitoring risks to patients The procedures in place for monitoring and managing risks to patient and staff safety had been improved significantly."

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 practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs."

Neutral

"• Arrangements were in place for planning and monitoring the number of 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

"Monitoring risks to patients The procedures in place for monitoring and managing risks to patient and staff safety were inadequate."

Positive

"The practice had developed a system for providing oversight for the management of high risk medicines such as lithium warfarin methotrexate and other disease modifying drugs which included regular monitoring in accordance with national guidance."

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

"There was no evidence of development plans for the staff members monitoring of performance and quality of care delivered."

Positive

"This ensured these medicines were dispensed only following appropriate monitoring tests."

Positive

"• The practice did have a system to receive and take action on safety alerts but did not have oversight of these for example a log for recording the alert and detailing any actions and outcomes to ensure future monitoring or shared learning."

Positive

"• GPs were assigned the lead role for long term conditions; the practice did not operate a practice based recall system to ensure patients that required regular monitoring were contacted for annual reviews."

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."

Positive

"Records showed medicine refrigerator temperature checks were carried out to ensure medicines and vaccines requiring refrigeration were stored at appropriate temperatures."

Positive

"• Records showed medicine refrigerator temperature checks were carried out to ensure medicines and vaccines requiring refrigeration were stored at appropriate temperatures."

Positive

"• Records showed medicine refrigerator temperature checks were carried out to ensure medicines and vaccines requiring refrigeration were stored at appropriate temperatures."

Positive

"The team included a GP specialist adviser a practice manager specialist adviser and a member of the medicine management team provided remote support."

Positive

"• A health and safety policy was available which identified staff with responsibility for health and safety within the practice."

Positive

"• The practice had improved the systems to assess monitor and mitigate risks to patients; For example risk assessments undertaken to ensure the health and safety of patients of receiving the care and treatment."

Positive

"For example The practice had not assessed the risks to the health and safety of service users receiving care and treatment."

Neutral

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

Positive

": Safe care and treatment The practice had not assessed the risks to the health and safety of service users receiving care and treatment."

Positive

"Areas for improvement Action the service MUST take to improve • The practice must assess the risks to the health and safety of patients of receiving the care and treatment and do all that is reasonably practicable to mitigate any such risks."

Positive

"• A health and safety policy was available which identified staff with responsibility for health and safety within the practice."

Positive

"• Practice staff had received some training deemed mandatory for example safeguarding of children and vulnerable adults but they had not received training in health and safety equality and diversity and infection control and prevention."

Positive

"The areas where the provider must make improvements are: • The practice must assess the risks to the health and safety of patients of receiving the care and treatment and do all that is reasonably practicable to mitigate any such risks."

Neutral

"This was intended to cover such topics as safeguarding infection prevention and control fire safety health and safety and confidentiality."

Positive

"• We found the practice did not have oversight of the progress of actions arising from a fire risk assessment and infection prevention and control audit."

Positive

"• We found the infection prevention and control audit had been completed in the weeks leading to the inspection; the audit did not contain an action plan and some of the findings were unclear if actions were required or had already been complete."

Positive

"• We found no concerns relating to infection prevention and control but the policies needed to be improved to ensure all information was easily available to all staff to maintain the standards required."

Positive

"• The policies available to staff for infection prevention and control did not contain sufficient detail to be assured that staff had easy access to all the information they required to meet and monitor the standards required."

Positive

"The practice nurse was named as the infection prevention and control IPC clinical lead and had received training and support from the lead nurse for IPC from within the local clinical commissioning group CCG."

Neutral

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

Neutral

"This was intended to cover such topics as safeguarding infection prevention and control fire safety health and safety and confidentiality."

Positive

"• The practice identified older patients who may need palliative care as they were approaching the end of life."

Neutral

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

Positive

"There were early and ongoing conversations with these patients about their end of life care as part of their wider treatment and care planning."

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

"• There was no running programme of continual clinical audit shaped to monitor and deliver improved outcomes for patients."

Positive

"The practice is committed to ensuring they sustain the improvements made by investing in protected time for clinical leadership use of a shared practice calendar and planned dates for meetings."

Positive

"• Continue to provide effective clinical leadership to ensure improvements are sustained and recently introduced systems and processes are embedded."

Positive

"• Ensure clinical leadership and recorded meetings are embedded to ensure safeguarding of children and adults and that information continues to be shared with and available to all appropriate staff."

Positive

"Action the service SHOULD take to improve • Continue to provide effective clinical leadership to ensure further improvements are made and recently introduced systems and processes are embedded."

Positive

"In addition the provider should; • Continue to provide effective clinical leadership to ensure further improvements are made and recently introduced systems and processes are embedded."

Positive

"• We found that there was clear clinical leadership in place meetings with other professionals such as health visitors and district nurses were recorded and the information shared in the practice to ensure that children and vulnerable adults were kept safe."

Neutral

"• During our previous inspection we identified that the practice did not provide clear clinical leadership or that clinical staff attended regular meetings that would safeguard children and vulnerable adults."

Positive

"• Although practice staff told us they felt supported by the GPs they reflected that they would benefit from more clinical leadership and guidance."

Positive

"• Undertake ongoing quality improvement activities such as clinical audits with suitable follow up to ensure improvements have been achieved."

Positive

"• The practice did not evidence ongoing quality improvement activities such as clinical audits."