Letter from the Chief Inspector of General Practice

The practice is rated good overall and good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 15 September 2016. The overall rating for the practice was good. However, a breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. We conducted a focused inspection on 22 March 2017 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 15 September 2016 we found the following area where the practice must improve:

• Establish appropriate security and tracking of blank prescriptions for use in printers.

• Conduct regular fire drills.

Our previous report also highlighted the following areas where the practice should improve:

• Continue to identify patients within the practice who are also carers.

• Ensure drug safety updates are acted upon in a timely manner, in accordance with practice policy.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 22 March 2017 we found:

• Arrangements were in place for the safe security and tracking of prescriptions

• The practice conducted regular fire drills in accordance with practice policy.

We also found the following in relation to the areas where the practice should improve:

• The practice was taking steps to identify patients within the practice who were also carers. There was information about services available to carers in the practice waiting room and on the website. Carers information packs were available at reception. The numbers of carers registered at the practice was now 72, which was an increase from 58 at the last inspection and represented more than 1% of the practice list.

• Drug updates were acted upon in a timely manner in accordance with practice policy. There was lead GP responsible for cascading alerts and subsequent actions were recorded.

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 Montpelier Surgery on 15 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were generally assessed and well managed. However blank prescription forms for use in printers were left in unlocked rooms during practice opening times and there was not a sufficient system for their tracking and on the day of inspection, and a fire drill had not been carried out for three years.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Establish appropriate security and tracking of blank prescriptions for use in printers.

• Conduct regular fire drills.

The areas where the provider should make improvements are:

• Continue to identify patients within the practice who are also carers.

• Ensure drug safety updates are acted upon in a timely manner, in accordance with practice policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Montpelier Surgery provides primary medical services from Monday to Friday for patients living in central Brighton. The practice is open from 8am till 6.30pm Monday to Friday, except onMondays where the practice remains open till 8pm and Wednesday morning where the practiceopens from 7.30am to accommodate those patients who work. The practice is also open every other Saturday. At the time of the inspection the practice had a patient list of 6,400. We were informed the practice was currently not accepting new patients.

The practice is run by two partner GPs. However, at the time of the inspection only one partner was registered with the Care Quality Commission. We were informed that the second GP was in the process of registering and we saw evidence of this. The practice was also supported by two salaried part time GPs, a practice nurse, a healthcare assistant, a team of reception, administrative staff and a practice manager.

On the two days of inspection we spoke with five administrative staff and three clinical staff members. This included the two partner GPs, the practice nurse and the practice manager. We were informed before the inspection date of the 4 June 2014 that a partner GP and practice manager would be unavailable. We therefore interviewed them before the inspection on 21 May 2014. During the inspection of 4 June 2014 we spoke with 11 patients who were visiting the practice on the day. We gained the views of the virtual patient participation group (PPG) via e-mail and asked patients for their views through comment cards left at the practice. We received 24 comment cards and received only two negative comments.

Patients we spoke with told us they felt respected, treated with dignity and were given appropriate information. The results of the Care Quality Commission comment cards showed that patients thought highly of the practice. There was praise for the practice nurse and reception staff. They also told us they had no concerns with getting appointments.

We spoke with a member of the clinical team who was appointed infection control lead. They were responsible for overseeing infection control at the practice and we saw evidence they had recently completed an infection control audit in April 2014. Patients were protected from risks associated with medicines due to there being correct procedures in place. We viewed the practices’ policies and procedures and found these to be up to date and appropriate. Staff were aware of safeguarding children and vulnerable adults and knew who to speak with if they had any concerns.

Staff told us although the practice had been through a recent leadership change, they still felt valued and appreciated. Staff received appropriate training and had their performance reviewed at annual appraisals. We saw evidence of team meetings where all staff were able to voice opinions and concerns. We saw these meetings also allowed for the cascade of information and gave opportunities for learning from events within the practice.

The practice had completed a patient survey and had responded to patients’ comments. The complaints procedure was on display in the waiting room and we saw evidence that complaints were handled appropriately and in a timely manner.