Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Malthouse Surgery on 10 February 2015. Overall the practice is rated as good. We found the practice to be good for providing safe, effective, caring and responsive services and for being well led. It was also good for providing services for the all of the six population groups we assessed.

During this inspection we followed up on concerns regarding safeguarding children and vulnerable adults and staffing checks identified during our previous inspection in July 2014. Following that inspection an action plan was sent to us by the practice, detailing how they would meet compliance. We found the practice had addressed the concerns we identified.

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.
• Communication channels and regular meetings were available to all staff which enabled them to be involved the running of the practice.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff training was monitored and training required by staff to fulfil their roles was delivered. However, Mental Capacity Act 2005 awareness among nursing staff and guidance to assist staff could be improved.
• Patient feedback showed 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 one area of outstanding practice:

• A blood sample centrifuge (required in preparing blood samples for testing) was available onsite meaning patients had greater flexibility in when they could have their blood tests undertaken.

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

The provider should :

• Provide nurses with awareness and guidance on the principles of the Mental Capacity Act 2005 to support them in considering the act in their roles.
• Test the spirometer in line with its manufacturer’s instructions to ensure it functions properly when used.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Malthouse Surgery is a general medical practice situated in the centre of Abingdon. Over 19,000 patients are registered with the practice. Around 25% of the registered patients are over the age of 65. The practice provides a range of services for patients which includes clinics for the management of long term conditions, family planning, travel and child health. Patients are signposted to and supported by other health care professionals who visit the practice and by local voluntary groups.

We spoke with 18 patients during our inspection and reviewed 27 comment cards completed by patients in the two weeks prior to our visit. Patients we spoke with complimented the care and support they received from the GPs and staff at the practice. We looked at the results of the last practice survey. This showed us that patients are pleased with the service they receive. We also spoke with the local team of NHS England, Healthwatch and the Oxfordshire Clinical Commissioning Group (CCG).

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.

The practice provided services that were safe. Current clinical guidelines were followed and referral systems operated efficiently. GPs and staff demonstrated a caring approach. Patients we spoke with told us they were treated with respect and with regard to their privacy. Services were responsive. A range of appointment times including evenings and every other weekend were offered. Systems were in place to respond to the needs of patients living in care homes. The practice was well led. There were clear lines of accountability and management of patient data and security of data was robust. Policies and procedures were not always reviewed regularly and some quality monitoring processes were not followed up.

Quality and Outcomes Framework data showed us the practice performed well in delivering care and treatment for patients with long term conditions. The needs of working age patients were recognised. A range of appointment times were available and telephone consultations could be offered. Mothers, babies and young children received services including childhood immunisation clinics and mother and baby health checks. The practice provided GP services to six care homes. We spoke with some elderly patients. They told us they received care and support from the GPs that met their needs. Patients in vulnerable circumstances who may have difficulty accessing services were supported. The practice offered services for patients experiencing poor mental health. Including counselling services at the practice premises.

We found the provider was in breach of regulations relating to:

- Safeguarding patients who use the service from abuse and

- Requirements relating to workers.

Services are provided from:

Malthouse surgery, The Charter, Abingdon, Oxfordshire, OX14 3JY

and

Appleton Surgery, Appleton Village Hall, Oakesmere, Abingdon, OX13 5JS

This practice is rated as Good overall. (Previous rating February 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Malthouse Surgery on 25 September 2018. This inspection formed part of our inspection programme.

At this inspection we found:

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice kept the appointment system under review and monitored the demand for appointments. GPs from the practice took an active role in providing weekday evening and weekend morning appointments for the wider Abingdon community.
• Patients recently reported they found the appointment system easy to use and that they were able to access care when they needed it. This had not always been the case before the changes to the appointment system.
• Major building refurbishment work was nearing completion. The refurbishment included creation of additional consulting rooms.
• The practice provided a wide range of online information about how to access the most appropriate health care and how to self-manage medical conditions.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• There was a significant event reporting system and when incidents did happen, the practice learned from them and improved their processes.
• The practice had systems to manage risk but these did not always work effectively in identifying and managing general health and safety risks.

There is one area where the practice must make improvement and this is:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

• Develop their system for identifying patients with a caring responsibility to encourage more to register.
• Continue to promote the benefits of the cervical screening programme to encourage greater uptake of this programme.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.