Archived: Orchard House Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard House Surgery on 10 May 2016. Overall the practice is rated as good.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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 were able to get an appointment with a GP when they needed one, with urgent appointments available the same day. The practice was part of a local group of practices who had worked together to open a primary care centre. The centre is open 8am to 8pm every day of the week and can be accessed by all patients registered with the practice.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
• The practice team was part of local pilot schemes to improve outcomes for patients in the area. For example, the practice had agreed to manage and lead the childhood immunisation service for all children within the Workington area. The same group of practices had recently introduced a FEAT team (Frail elderly and vulnerable adult team); with the aim of providing patients with bespoke support and preventing unnecessary hospital admissions.

We saw some areas of outstanding practice:

• Due to a lack of health visitors in the area, some 500 children across all practices had not received timely childhood immunisations. The practice had therefore agreed to manage and lead the childhood immunisation service for all children within Workington. An area within the practice was refurbished to provide a dedicated waiting area for families and children who were attending for immunisations. As a result, the backlog of immunisations was cleared and immunisation targets were achieved.
• Vulnerable patients were provided with a dedicated telephone number to contact the practice; a different ring tone was assigned and the telephone screen showed the word ‘vulnerable’; this alerted staff that a vulnerable person was on the telephone and may have needed urgent assistance.

The areas where the provider must make improvements are:

• Ensure appropriate arrangements are in place for the proper and safe management of medicines; including monitoring the temperatures of the refrigerators used to store vaccines, maintaining records of blank prescription form serial numbers in line with guidance issued by NHS Protect and checks to ensure changes made to patients’ records made by non-clinical staff are correct.

In addition, the provider should:

• Review the arrangements to enable patients to summon support to access the surgery.
• Put arrangements in place to ensure there is a practice-wide approach to the review of any new or revised clinical guidelines.
• Arrange appraisals for all staff for the current year.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice