This practice is rated as Good overall. (Previous inspection 14 January 2016 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced inspection at Alveley Medical Practice on 28 February 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The system in place for monitoring and manging patient medicine and safety alerts at the time of the inspection was not failsafe. The practice following the inspection immediately rectified this and has taken appropriate action.
• Improvements were needed in patient group directions, medicines refrigeration monitoring and to ensure that medicines dispensed in trays do not include tablets surrounded by the foil blister packaging.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. The national patient survey findings reported higher patient access satisfaction rates than that of the local clinical commissioning group and national averages.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had set up a Dementia Café at the local chapel with the support from their Patient Participation Group. Carers of patients with dementia attended this café and feedback received was extremely positive. The café was well attended and plans had further developed with a local care home and staff at the practice to run a Dementia Café from the care home.
• The practice completed a mental health ward round once a month at a local care home with the support of a Consultant Psychiatrist. The practice was the pilot for this service and following its success it was being considered for roll out to other practices in the area.

The areas where the provider must make improvements are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular:

• Medicines dispensed in packs/trays must not include tablets surrounded by the foil blister packaging.
• All patient safety alert systems to include evidence of the actions the practice has taken.
• Continue with the governance improvements made in respect of patient group directions and fridge temperature monitoring.

The areas where the provider should make improvements are:

• Continue with the governance improvements made in respect of patient group direction monitoring.
• Continue with the governance improvements made in medicines refrigeration monitoring.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alveley Medical Practice on 14 January 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example following a significant event the safeguarding team were contacted as the practice had been informed that they could not refer twice. The safeguarding team reviewed the procedures and emailed practices with the changes made.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the practice had offered extended hours since 2009 for it patients on Wednesday mornings from 6.45am.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice purchased a Doppler machine to support its patients and 24 hour blood pressure monitoring to provide these as in house services to its patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had completed audits which demonstrated improved outcomes for patients. For example, the practice had completed an audit in 2015 which showed of those patients who had expressed a preference, 90.9% patients died at home (their preference) with the practice and community care and support.

• The practice had been proactive in improving the availability of services for people with mental health problems. For example, the practice completed joint monthly visits with a Consultant Psychiatrist from the Community Mental Health Trust (CMHT). This was to improve access to CMHT and due to a high number of referrals concerning mental health issues.
• The practice in 2015 completed an audit on timescales for repeat prescriptions. The findings were that on average it took 0.7 days to dispense a prescription. This demonstrated the efficiency of the repeat prescriptions processes and that they regularly exceeded their own standard operating procedure expectations, which suggested medicines be dispensed within 48 hours.

However there were areas of practice where the provider should make improvements:

• Consider implementing a more robust system to ensure appropriate action is taken should patients who were not eligible to use the practice dispensary not collect prescriptions.

• Consider a lightweight carrier vessel for the portable oxygen supply to enable safe and easy transportation of oxygen by staff.

• Ensure that actions required in the practice Legionella report and already completed by staff are documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice