Morland Road Surgery

Updated 15 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced desk-based inspection of Morland Road Surgery on 14 October 2016. Overall the practice is rated as good.

We had previously conducted an announced comprehensive inspection of Morland Road Surgery on 17 February 2016. As a result of our findings during the visit, the practice was rated as good for being effective, caring, responsive and well-led and requires improvements for safe. We found that the provider had breached Regulation 12 (1)(2)(f) Safe care and treatment.

We also asked the practice to review their processes for infection control procedures ensuring that curtains were changed at appropriate intervals; review the induction process for new staff ensuring that it was up to date and relevant to staff roles and review patients’ access to female GPs. These reviews did not relate to regulatory breaches, they were merely suggestions to improve the service.

The provider sent us evidence to confirm that they had reviewed all these areas. As a result the following had been put in place:

• Curtains had been changed in all surgeries and arrangements had been put in place to change them periodically at appropriate intervals.

• Patients had access to a GP of their choice. A female GP was now available to patients three days a week.

• The induction process has been updated. We saw that induction processes were relevant to staff roles and included relevant training.

The practice also wrote to us to tell us what they planned to do to make improvements and meet their regulatory requirement.

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

• Risks to patients were assessed and well managed.
• There was equipment and medicines available in the event of a medical emergency.
• Appropriate checks were carried out to the equipment and the expiry of medicines was monitored.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 4 May 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• There were 419 patients on the diabetes register. 92% of patients with diabetes on the register had been immunised against influenza.

• Longer appointments and home visits were available when needed.

• The practice did in-house insulin conversion for diabetic patients.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice often ran specialist clinics on Saturdays to meet the needs of this patient group.

Updated 4 May 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to the CCG and national rates for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• All children under six were given on the day appointments.

• The practice offered a full contraception service including coil fitting and implants.

• A baby clinic was held weekly by one of the GPs or the nurse.

• A full antenatal clinic was offered including midwife appointments. One of the GPs was an obstetric and gynaecology registrar so was able to provide more specialist care.

Updated 4 May 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Including regularly visiting three local care homes in the area providing weekly sessions.

• The practice offered dementia screening.

• The practice worked closely with district nursing to jointly meet the needs of older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Flu and pneumococcal vaccinations were offered to all older patients.

Updated 4 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Appointments could be pre-booked in advance and the practice offered morning and afternoons. Telephone consultations were also available every day.

• Extended hours were offered at various times.

• Opportunistic health checks were carried out including weight, blood, lifestyle advice and routine HIV testing.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 4 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 93% of patients with physical and/ or mental health conditions notes had record smoking status in the preceding 12 months.

• There were 107 patients on the mental health register. Only 66% of these patients had a comprehensive care plan documented in the preceding 12 months.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 4 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers, sex workers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability and other patients whose circumstances make them vulnerable.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.