All inspections: Bungay Medical Practice

We carried out an announced comprehensive inspection at Bungay Medical Practice on 9 May 2017. Overall the practice is rated as requires improvement.

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

Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
Patients we spoke with 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.
Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
The practice had good facilities and was well equipped to treat patients and meet their needs.
Staff demonstrated that they understood their responsibilities in relation to safeguarding children and vulnerable adults. However, some staff we spoke with were unclear about whom the local or regional leads were.
There was a system for reporting and recording significant events; however learning outcomes from events were unclear. Significant events were not always discussed at meetings in a timely manner.

Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns but learning outcomes were not always recorded.
ECCH had a clear vision and set of values and but some staff at the practice were not aware of these. Whilst staff felt supported by local leadership, they recognised that ECCH were still in the process of developing those relationships and support structures. The communication between the provider and the location had not always been effective. This had resulted in delays in information being shared and recommendations being acted upon.
The training matrix for staff showed training had not always been completed in areas such as basic life support and safeguarding relevant to their role.
We found out of date medicines and devices in GP bags.
The practice was signed up to receive some, but not all Medicines and Healthcare products Regulatory Agency (MHRA) alerts. The practice had a record of alerts they had received and these were actioned appropriately. The practice signed up to receive all remaining alerts on the day of the inspection.
Some standard operating procedures for the dispensary had not been reviewed since 2013.
The infection control lead had not received training specific to the role and a sharps bin was out of date.
The practice had identified less than 1% of the practice population as carers and had not offered these patients carer health checks.

We saw two areas of outstanding practice:

East Coast Community Healthcare (ECCH) were actively implementing new models of care; for example they employed a physiotherapist, health trainer and community matron to work at the practice. The physiotherapist saw patients with musculoskeletal pain. Patients could book directly with this service ensuring they had timely advice in the management of conditions such as back pain. This benefitted the patient who did not have to be referred to other services which often incurred protracted delays and the risk of their condition deteriorating. The physiotherapist would triage patients and refer back to the GP if inappropriate. The physiotherapist was available to the GPs and nurses for immediate advice if they needed their specialist skills. Between March and April 2017, the physiotherapist saw 86 patients. Of these, only 1% was referred to a GP and 93% were managed with exercises and advice alone.
The practice offered a ‘same day team’ which included clinical led triage, same day appointments for vulnerable patients and same day home visits by a primary care practitioner for patients who had conditions making it difficult to attend the practice. The emergency care practitioner was a trained paramedic who liaised with the GP after or during every visit. The community matron was also part of this team and offered same day appointments for acute social problems. The nurse team also had 30 appointments available daily for patients with minor illness.

The areas where the provider must make improvements are:

Implement an effective process to ensure that medicines kept in GP’s bags are checked routinely and are safe to use.
Ensure all safety alerts are received, actioned and shared.
Ensure there is an effective system in place to monitor that actions from significant events are completed and recorded and learning is shared with staff, including dispensary significant events.
Ensure standard operating procedures for the dispensary are reviewed and updated.
Implement an effective system for monitoring staff training to ensure staff are up to date for mandatory training including safeguarding and basic life support.

The areas where the provider should make improvement are:

Continue to identify carers and consider the need for health checks and additional support for this patient group.
Continue to work towards effective communication to ensure staff understand their roles in relation to incident reporting and complaints.
Consider the need for additional training for the infection prevention and control lead and ensure infection prevention and control audits are always effective.
Ensure actions taken in response to complaints are always documented.
Ensure all equipment is calibrated to ensure it is safe and effective for use.

Chief Inspector of General Practice

Archived: Bungay Medical Practice