Letter from the Chief Inspector of General Practice

We carried out an inspection of Orchard Surgery on 4 September 2014 and at that time we found that some improvements were required. We found that annual staff competency assessments for dispensing were not completed. We found that the complaints systems was not clearly brought to the attention of service users. In addition we found that significant events, complaints and incidents were not managed in a systematic and standardised way to identify risk and share learning across the whole team.

We carried out an announced comprehensive inspection at Orchard Surgery on 7 May 2015. The practice had introduced systems and processes to ensure its significant event, incident and complaints procedures were reviewed and any learning needs identified and shared with the whole practice team. In addition we saw relevant training and annual assessment of competence had been completed for staff. Overall the practice is rated as good.

We found the practice to be safe, effective, caring, responsive to people’s needs and well-led. The quality of care experienced by older people, by people with long term conditions and by families, children and young people is good. Working age people, those in vulnerable circumstances and people experiencing poor mental health also receive good quality care.

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

• The practice was a friendly, caring and responsive practice that addressed patients’ needs and worked in partnership with other health and social care services to deliver individualised care.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned for.
• Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

Improve the arrangements for the security of medicines waiting to be collected and the security of blank prescription forms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Orchard Surgery provides primary medical services to people living in the village of Melbourn, Hertfordshire and the surrounding areas.

There are approximately 7,500 patients registered at the service with a team of five GP partners. GP partners held managerial and financial responsibility for running the business. In addition there is an additional salaried GP, three registered nurses, three health care assistants, a practice manager, an assistant practice manager, nine administrative staff and six dispensers.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

The practice provides services to a diverse population age group, is situated in a semi-rural location and is a dispensing practice. A dispensing practice is where GPs are allowed to dispense the medicines they prescribe for patients who live remotely from a community pharmacy. Not all patients at the practice are entitled to this service.

Patients told us they feel that the practice is safe. They told us that care is given to them in accordance with their wishes and opportunities are given for informed decision making. Patients told us they feel the practice was responsive to their needs. For example, patients said that an urgent appointment could always be obtained on the day they contact the practice and they could usually see their named GP for non-urgent visits. This reflected the information provided on the practice website.

Patients told us about their experiences of the practice. Their responses were positive from the 20 patients we spoke with on the day, from the six patient participation group members, in the five comment cards left for us and within the practice’s own patient survey 2012/13. PPGs are groups of active volunteer patients that work in partnership with practice staff and GPs to achieve high quality and responsive care.

Patients were pleased with the care they received and were very complimentary about the staff at the practice. There were sufficient staff working at the practice. However, the lack of overview on staff training meant that some staff had not had their clinical competency assessed and had missed some training. Medicines were well managed in the practice and within the dispensary and systems were in place to monitor medicines management. The practice was visibly clean and had effective infection control processes in place.

Patients said they felt safe in the hands of the staff and felt confident in clinical decisions made. There were effective safeguarding procedures in place.

Significant events, complaints and incidents were investigated, although the process followed was informal and inconsistent. There was no evidence to show that all staff had been informed about the outcome, learning and actions taken following such investigations.

Recruitment, pre-employment checks and induction processes were robust. A new phase of staff appraisals had also been welcomed by staff.

The practice was effective in the way it provided care to patients. Documentation we reviewed about the practice demonstrated the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

The practice was not always well led or proactive in monitoring the safety and effectiveness of the service provided. Some approaches to significant events, consent and complaints were managed in different ways by the GPs. This lack of systemic standardised approach meant that learning and changes in work patterns were not always shared with the wider staff group. There was insufficient evidence to show that the practice actively sought the views of patients or staff to monitor the effectiveness of the care provided.

Patients were unclear about how they would raise a complaint. Complaints were not managed in a consistent way and the policy did not reflect recognised complaint guidance and contractual obligations for GPs in England.

The staff spoke highly of the management within the practice and told us they felt supported in their roles. However, there was no formalised protected time to share learning and discuss changes to guidelines and protocols.