Letter from the Chief Inspector of General Practice

We carried out an announced focussed follow up inspection at Drs Nodder Morgan and Taubman on 8 March 2017. This inspection was to follow up on action taken after we inspected on 17 September 2015. At the inspection on 17 September 2015 the overall rating for the practice was good but we rated the safe domain as requires improvement. The full comprehensive report on the September 2015 inspection can be found by selecting the ‘all reports’ link for Drs Nodder Morgan and Taubman on our website at www.cqc.org.uk .

This inspection was an announced focused inspection carried out on Wednesday 8 March 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 17 September 2015. This report covers our findings in relation to the requirement and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings from this inspection were as follows:

• Failsafe recruitment processes had been introduced to ensure pre-employment references were obtained and risk assessments introduced for staff assessed as not requiring a disclosure and baring service (DBS) pre-employment checks.

• Medicines in the practice and dispensary continued to be managed well and had been further improved in relation to the ordering of controlled drugs.

• The management of significant events at the practice continued to be managed well and trends had been identified which showed positive outcomes regarding the care of patients who were at the end of life.

• Adult safeguarding policies had been improved immediately following the last inspection and were now based on current practice guidelines set by the Wessex area team.

• The procedure for the insertion of intrauterine coils had been amended to align with practice guidance set out by the Royal College of Obstetricians and Gynaecologists.

• The infection and prevention and control processes and environmental health and safety risk assessments continued to be managed well.

• Systems were in place to maintain and monitor equipment in the practice was well managed.

• Arrangements were in place to monitor staffing numbers and skill mix and included the introduction of locality carers to provide care for end of life and vulnerable patients.

• Effective arrangements were in place to manage emergencies and incidents.

We saw one outstanding aspect of care:

The practice had been recognised by healthcare professionals and members of the local community for providing a high standard of care and treatment for end of life care. The GPs worked effectively with the district nursing teams to provide continuity of care and prompt symptom relief for patients at the end of their life in the rural community. The practice had received positive feedback from palliative care hospital consultants and many letters of thanks from patients’ relatives. The GPs reviewed end of life care as positive significant events which had identified effective team work, prompt pain relief and respecting patient’s wishes of where they chose to die. The practice had employed locality carers to help with the social needs of these patients and the lead GP for palliative care shared their personal mobile telephone number with district nurses and patient’s relatives so continuity of care could be provided in addition to the out of hours service provider. The practice sent relatives letters of the anniversary of the patients death and practice staff often attended patient funerals. Records for the use of locality carers showed that these staff had made 97 visits saving the Clinical Commissioning Group (CCG) £5,400 over a six month period.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Nodder Morgan and Taubman on 17 September 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive. However, the practice requires improvement in providing safe services.

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 recruitment checks.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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 well 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.

We saw an area of outstanding practice:

• The practice was proactive in screening patients for dementia. The lead GP ran an in house memory clinic and used an accredited questionnaire to assess for symptoms of dementia and carry out investigations. If appropriate patients were commenced on medicines which delay some of the symptom of dementia. A GP with extra training dementia care reviewed the care and treatment of all patients living with dementia at least once a year.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure all policies and procedures for the running of the practice are maintained, accurate and up to date.

In addition the provider should:

• Review the legionella risk assessment to ensure all actions have been taken.

• Review the contents of the emergency medicine pack in line with best practice.

• Review the procedures for ordering controlled drugs.

• Follow guidance from the Royal College of Obstetricians and Gynaecologists on insertion of intrauterine contraceptive devices.

• Appropriately test, service and maintain all equipment to ensure it is fit for use.

• Formalise the appraisal and training system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice