- GP practice
Archived: Dr Philip Mackney Also known as The Elgin Clinic
Important:
The provider of this service changed. See new profile
All Inspections
05 April 2018
During a routine inspection
We carried out an announced comprehensive inspection at Dr Philip Mackney (The Elgin Clinic) on 20 June 2017. The overall rating for the practice was Requires Improvement. The full comprehensive report on the 20 June 2017 inspection can be found by selecting the ‘all reports’ link for Dr Philip Mackney on our website at www.cqc.org.uk.
This inspection, on 5 April 2018, was an announced comprehensive inspection to confirm that the practice had carried out their plan to meet the requirements that we identified in our previous inspection on 20 June 2017. This report covers our findings in relation to those requirements and any improvements made since our last inspection. The practice is now rated as Good overall.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
At this inspection we found:
- The practice had addressed the findings of our previous inspection in respect of significant events, patient safety alerts, repeat prescribing, prescription management and premises and health and safety risk assessments.
- There were systems in place to safeguard children and vulnerable adults from abuse and staff we spoke with knew how to identify and report safeguarding concerns.
- There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
- The practice had systems in place to ensure care and treatment was delivered according to evidence-based guidelines.
- Some patient outcomes, for example, those with long-term conditions were below local and national targets. However, we saw that improvements had been made and the practice had plans in place to further address these shortfalls.
- Results from the national GP patient survey showed patients rated the practice comparable with others for aspects of caring. Patients told us 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. Improvements were made to the quality of care as a result of complaints and concerns.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients were able 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
The areas where the provider should make improvements are:
- Review the arrangements for raising concerns around controlled drugs with the NHS England Area Team CD Accountable Officer.
- Review the understanding of reception staff of ‘red flag’ sepsis symptoms that might be reported by patients and how to respond.
- Continue to monitor patient outcomes in relation to patients with long-term conditions, mental health and the childhood immunisation programme.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
20 June 2017
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Philip Mackney on 24 September 2015. The overall rating for the practice was good with requires improvement for providing safe services. The full comprehensive report on the 24 September 2015 inspection can be found by selecting the ‘all reports’ link for Dr Philip Mackney on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 20 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 24 September 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is now rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
- Although risks to patients were assessed, the systems to address these risks were not implemented well enough to ensure patients were kept safe. For example, we found the processes and management of significant events, patient safety alerts, repeat prescribing, prescription management and risk assessments required improvement.
- Staff we spoke with were aware of current evidence based guidance. However, there were no systems in place to ensure all staff were up-to-date or following guidance.
- Clinical protocols were not available to support the scope of responsibility undertaken by the healthcare assistant.
- Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
- There was no quality improvement programme and little evidence that clinical audits were driving improvements to patient outcomes.
- Results from the national GP patient survey showed patients 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.
- 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.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a leadership structure and staff felt supported by management.
- The practice had a number of policies and procedures to govern activity, but some contained out-of-date information.
- The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
The areas where the provider must make improvement are:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvement are:
- Review the infection control audit to ensure all improvements identified have been actioned and consider the infection control lead undertaking enhanced training to support them in this extended role.
- Continue to monitor patient outcomes in relation to the childhood immunisation programme.
- Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
- Consider displaying the mission statement in a location visible to patients.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
24 September 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Philip Mackney on 24 September 2015. Overall the practice is rated as good.
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.
Our key findings across all the areas we inspected were as follows:
- 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.
- Risks to patients were assessed and well managed with the exception of those relating to legionella.
- Patients’ needs were assessed and care was planned and delivered following best practice guidance. Most staff had received training appropriate to their roles and any further training needs had been identified and planned.
- There was evidence of audit cycles to show that audits were driving improvement in performance to improve patient outcomes; however some audits had not been completed.
- 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.
- Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
- The practice had good facilities and was 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 practice had a number of policies and procedures to govern activity, and these had been reviewed.
- The practice held regular clinical meetings however general governance meetings were not formalised and learning shared at these meeting was not documented.
There are areas of practice where the provider needs to make improvements.The provider should:
- Ensure oxygen is maintained and staff know of its availability.
- Ensure all staff are up to date with the appropriate level of safeguarding training.
- Ensure all audits undertaken are completed.
- Ensure that all patients who have long-term conditions and poor mental health receive structured annual reviews.
- Ensure the cleaning schedule log is completed to demonstrate that cleaning tasks have been carried out.
- Ensure that governance meetings are formalised and minutes are recorded from these meetings to document discussions and learning shared.
- Ensure all carers are identified on the register.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice