This practice is rated as good overall. (Previous inspection report published 19 January 2018 - Good).

The key questions are rated as:

Are services safe? Good.

We carried out an announced comprehensive inspection at Orchard Street Medical Practice- White on 27 November 2017 as part of our regulatory functions. The practice was rated as good overall, and requires improvement for providing safe services. We carried out an announced focused inspection on 2 July 2018 to follow up on the breach of regulation identified at the 27 November 2017 inspection. At the 2 July 2018 we inspected the safe key question.

At this inspection we found:

• All staff received up-to-date safeguarding children and vulnerable adults training appropriate to their role.
• Appropriate arrangements were in place to manage infection prevention and control.
• Effective systems and processes were in place to ensure there was oversight and safe management of safety alerts within the practice.
• Information was available to support carers and staff were aware of the support services available for carers. The practice had written and implemented a carers policy, which staff were aware of.
• Information about how to make a complaint or raise concerns was easily available at the practice and this information was up-to-date.
• Annual health checks for people with a learning disability were offered by the practice. The practice currently had 73 patients on the learning disabilities register who were eligible for a health check. From April 2017 to March 2018, 58 of these patients had received a health check, 13 had declined a health check and two patients had recently registered at the practice. The practice continued to work with a learning disability nurse to support patients who had declined a health check.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice.

Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (Previous inspection report published 9 July 2015 - Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students - Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Orchard Street Medical Practice - White on 27 November 2017 as part of our regulatory functions.

At this inspection we found:

• The practice had an effective system in place for recording, responding and learning from significant events. However, they did not have complete oversight of safety alerts which included Medicines & Healthcare products Regulatory Agency (MHRA) alerts. Following our inspection the practice completed a review of MHRA alerts since March 2016 and provided evidence of regular discussion at clinical meetings.
• Whilst the overview record of staff training was not effectively completed, which the practice explained was due to information technology issues, they could evidence that the majority of staff had completed training deemed mandatory by the practice. However two clinical staff members had not completed safeguarding children and vulnerable adults training appropriate to their role. One GP was overdue their refresher training for basic life support and anaphylaxis. Training was arranged following our inspection.
• Infection control policies and procedures were in place and a number of audits were completed and actions identified were acted on. The practice did not record the Hepatitis B immunity of all non-clinical staff, who were at risk as they were responsible for the cleaning of spilt body fluids. Written risk assessments had not been undertaken in relation to the roles the practice required these staff to undertake.
• Appropriate recruitment arrangements were in place and staff received an induction applicable to their role. Appraisals had been completed in the staff files that we viewed and staff we spoke with confirmed they had received an annual appraisal.
• The practice had systems in place for the appropriate and safe handling of medicines.
• 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.
• The practice were very aware of the specific needs of their patient population. This included a significantly higher than average number of patients between the ages of 20 and 44, and with significantly higher deprivation levels than the clinical commissioning group (CCG) average. The practice had a high transient population and many patients for whom English was not a first language. Staff involved and treated people with compassion, kindness, dignity and respect. We saw examples of this during the inspection.
• The practice had less than 1% of the practice population identified as carers. This figure was low due to the significantly lower number of older patients registered at the practice. Information was available for carers, although not all the staff we spoke with were aware of the services available for carers and how to signpost patients to these services.
• Annual health checks for people with a learning disability were offered by the practice. The practice currently had 76 patients on the learning disabilities register who were eligible for a health check; 29 of these patients had received a health check since April 2017. The practice had plans to invite patients for a review and worked with a learning disability nurse to support this work.
• All of the patients we spoke with and received comments from found the appointment system easy to use and reported that they were able to access appointments easily. This was supported by a review of the appointment system and data from the national GP Patient Survey. Some patients advised that they did not always have consistency of GP, although this was available if you could wait.
• There was an effective system for responding to and learning from complaints. Information on the practice’s complaints procedure was not easily available in the practice, although it was on the practice’s website.

The areas where the provider must make improvements as they are in breach of regulations are:

• 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:

• Staff at the practice should be aware of the support services available for carers and be able to signpost carers to these services.
• Information about the practice’s complaints procedure should be updated and easily available at the practice.
• Continue with plans to invite patients with a learning disability for a health check.

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 Orchard Medical Practice on 12 March 2015. Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe, caring, responsive and effective services and for being well led. It was also good for providing services for older people, people with long term conditions, families, children and babies, working age people, people whose circumstances make them vulnerable and people experiencing poor mental health.

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

• Systems were in place for the learning and improvement from safety incidents. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were evident.

• The staff at the practice demonstrated sound knowledge and understanding in relation to their practice population. A multi-disciplinary team approach to care was evident.
• All staff had a good awareness of the needs of patients whose circumstances made the vulnerable. We saw numerous examples of the proactive and person centred approach for individual patients. The practice were proactive in identifying and providing additional support to patients and in working with other agencies. We saw how people had been supported to maintain their independence and to live at home and access community and voluntary services. This helped ensure their welfare.
• Feedback we received from patients on the day of the inspection was generally positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available to patients.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had a good skill mix of clinical and non-clinical staff.

• There were shared values across all staff groups and staff told us they felt supported by the management team.

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

Importantly the provider should

• Consider the frequency of infection control audits and training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice