Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Milton Surgery on 27 April 2016. At this time we noted that systems and processes were not established and operated effectively to ensure that clinicians were overseeing and checking changes to patients’ prescriptions. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to ensuring effective processes were in place.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link for on our website at www.cqc.org.uk

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 Milton Surgery on 27April 2016. Overall the practice is rated as good.

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

• Patients expressed high levels of satisfaction with the practice, citing caring and attentive staff, ease of access and being involved in decisions about their treatment as the reasons. Figures from the national GP survey stated that 92% of patients would recommend the surgery to someone new in the area.

• There was an open and transparent approach to safety and effective systems in place to report and record significant events which enabled learning to be shared.

• The practice worked closely with other health and social care teams, and local community organisations such as the Alzheimer’s Society and community wardens to deliver co-ordinated and effective care for patients.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Patients’ long-term conditions were managed well, and they received regular health checks and medicines reviews.

• The practice had an active patient participation group that it worked closely with to improve its services.

• Staff were well supported and received good training for their role.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

• Ensure that any changes to patients’ medicines following their discharge from hospital or out patients’ appointments are checked by a clinician.

The areas where the provider should make improvement are:

• Ensure that more secure arrangements are in place for prescription forms and medicines held in the dispensary so that they are only accessible by authorised dispensers and GPs.

• Keep a record of near-miss dispensing errors to monitor trends and ensure appropriate actions are taken to minimise the chance of similar errors occurring again.

• Review and update protocols for the management of controlled drugs within the practice

• Ensure that a record of staff recruitment interviews is made.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients we spoke with were generally happy with the service they received at Milton surgery. They spoke positively about the staff employed at the practice. Patients told us they felt that the practice was safe and that care was given to them in accordance with their wishes. They told us the practice was responsive to their needs. For example urgent appointments could be obtained on the day the patient contacts the practice. This reflected the information provided on the practice website. Patients told us about their experiences of the practice. The responses were positive from the patients we spoke with on the day, the comments cards completed and the practice’s own survey completed in 2013, (150 questionnaires were sent out and100% patient response received) .

There was evidence of investigation and learning from incidents, with changes implemented to improve patient care. The practice was effective in the way it provided care to patients. Clinical audits of patient care and prescribing were undertaken. There was evidence of response to staff training requirements. There were clear management structures at the practice. Staff told us they felt supported and spoke highly of the GPs and management team. We saw there were systems in place which regularly monitored the safety and effectiveness of the care provided.

In advance of our inspection we talked to the local clinical commissioning group (CCG) and the NHS local area team about the practice. Neither of these organisations had any significant concerns about it.

We also examined patient care across the following population groups: older people; those with long term medical conditions; mothers, babies, children and young people; working age people and those recently retired; people in vulnerable circumstances who may have poor access to primary care; and people experiencing poor mental health. We found that care was tailored appropriately to the individual circumstances and needs of those patients in these groups.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.