Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakham Medical Practice on 17 January 2017. The overall rating for the practice was good. The full comprehensive report on the 17 January 2017 inspection can be found by selecting the ‘all reports’ link for Oakham Medical Practice on our website at www.cqc.org.uk.

However at that inspection we found that:

• Blank prescription pads were not being managed correctly.

• Risks to patients and others had not been properly mitigated. There had been no inspection of fixed electrical wiring .

We issued the provided with requirement notices for breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice was rated as ‘requires improvement’ in the safe key question.

In addition we also found that:

• The practice should address the issues highlighted in the national GP survey in order to improve patient satisfaction including access to appointments and ease of getting through to the practice by telephone.

• The practice should review risk assessments in place for non-clinical members of staff who did not have a Disclosure and Barring Service (DBS) check to ensure the rationale for not requiring a DBS check was documented.

• The practice should review processes in place in relation to clinical audits to ensure full cycle audits are carried out to improve patient outcomes.

• The practice should review the system of appraisals to ensure all members of staff receive an appraisal at least annually.

This inspection carried out on 1 June 2017 was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 17 January 2017. This report covers our findings in relation to those requirements and to other improvements they had made.

Specifically we found that:

• The practice had an effective system to manage the security of blank prescription forms.

• The buildings had been inspected to help ensure their electrical safety.

• The practice had taken action to address the low satisfaction scores for telephone access.

• There was a clear and effective system in place to ensure that staff were subject to a DBS check or risk assessment where this was not the case.

• The practice had carried out and were continuing to carry out full cycle clinical audits.

• There was an effective system to ensure all staff received an annual appraisal.

Overall the practice is rated as ‘Good’. It is also rated as ‘Good’ in the safe key question.

It was already rated as ‘Good’ in the effective and responsive key questions and these ratings have not changed.

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 Oakham Medical Practice on 17 January 2017. 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.
• 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.
• The practice engaged in a scheme funded by the CCG which included four other local practices whereby an integrated care co-ordinator employed by Rutland County Council worked in the practice two days per week. This co-ordinator worked specifically with patients both in-house and in the community who suffered with long term conditions or were frail and at risk of falls and had been identified as at risk of unplanned admission to hospital.
• Community diabetes nurse specialists worked in partnership with the practice and joined weekly nurse led diabetes clinics to review the management of diabetic patients and discuss pathways and agree join management plans for patients.
• The practice provided a daily outreach clinic at a local school within its medical centre which was GP led. Pupils were guaranteed same day appointments with a GP during lunchtime clinics.
• 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.
• Risks to patients were assessed and well managed with the exception of those in relation to electrical and fire safety.
• The practice had a system in place to ensure the safe storage of blank prescriptions and however, the system for monitoring their use required review.
• 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 improvement are:

• Ensure that there are appropriate systems in place to properly assess and mitigate against risks including risks associated with electrical and fire safety.

• Review system in place to ensure the safe storage of blank prescriptions and monitoring of their use.

The areas where the provider should make improvement are:

• Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including access to appointments and ease of getting through to the practice by telephone.

• Review risk assessments in place for non-clinical members of staff who do not have a DBS check in place to ensure rationale for not requiring a DBS check in place is documented.

• Review processes in place in relation to clinical audits to ensure full cycle audits are carried out to improve patient outcomes.

• Review system of appraisals to ensure all members of staff receive an appraisal at least annually.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with six patients all of whom spoke of the practice in complimentary terms. Patients told us, "The quality of care is second to none. The GPs go the extra mile." Another patient told us, "The care is continuous, the GPs are excellent. They give space and time for me to have a say about my own care. The nursing staff are brilliant."

Patients told us that they had been able to make appointments at times that suited them and with a GP of their choice. One patient said, "I've always managed to see the doctor I've wanted." Another patient told us that they had not always seen the same GP but that had not been an issue. A newly registered patient told us, "The registration procedure was helpful and I was able to make an appointment at a time I wanted."

We found that patient's views and experiences had been taken into account by the practice. Patients had opportunities to provide feedback and comments using suggestions cards. The practice had an active and influential patient participation group that represented patient's views and which was valued and listened to by the practice.

We saw that care and treatment was provided in a clean environment because the practice had effective cleaning and infection control procedures. Patients were safe because the practice had effective adults and children safeguarding procedures.

The practice had quality monitoring systems and trained staff that ensured the practice was effectively run.