Updated 31 October 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Martins Oak Surgery on 13 January 2016. Breaches of legal requirements were found during that inspection within the safe and effective domains. The practice was rated as requires improvement overall, requires improvement in the safe and effective domains and good in the caring, responsive and well-led domains. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:
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Ensuring that the practice holds a child protection register of all children considered to be at risk.
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Ensuring that the practice has a clear adult safeguarding protocol in place and that all staff are aware of how to raise concerns outside of the practice.
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Ensuring that all staff attend relevant safeguarding training including reception and administrative staff and that all GPs have attended level three training in children’s safeguarding.
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Ensuring that the practice maintains a log of all staff training and that mandatory training requirements are met for all staff.
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Ensuring that environmental and legionella risk assessments are carried out and regularly reviewed.
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Ensuring that infection control procedures are clearly embedded and include regular annual infection control audits with action taken, the appointment of a dedicated infection control lead and infection control training for all staff.
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Ensuring that there is a system in place to monitor the use of prescription sheets stored in printers including ensuring they are locked away when not in use.
We undertook a focused inspection on 23 August 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and was rated as good overall and good under the safe and effective domains. This report only covers our findings in relation to those requirements.
This report should be read in conjunction with the last report from January 2016. Our key findings across the areas we inspected were as follows:
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The practice held a child protection register of all children considered to be at risk.
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The practice had an adult safeguarding protocol in place and staff were aware of how to raise concerns.
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All staff had undertaken both child and adult safeguarding training appropriate to their role within the stated timeframe. All GPs had attended level three training in child safeguarding.
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The practice maintained a comprehensive log of staff training requirements and staff had completed mandatory training such as safeguarding, basic life support and infection control.
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The practice had carried out environmental and legionella risk assessments and had identified review dates.
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The practice had a dedicated infection control lead. The audit had been repeated by the infection control lead and action had been taken on the findings. All staff had received appropriate training in infection control.
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The practice had a system to ensure the security of printer prescriptions when not in use and have put in place a new system to monitor the use of blank printer prescription sheets.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice