Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orford Lodge Surgery on 13 December 2016. The overall rating for the practice was good. However, we identified a breach of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services.

The full comprehensive report from the 13 December 2016 inspection can be found by selecting the ‘all reports’ link for Orford Lodge Surgery on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- Safe care and treatment.

The area identified as requiring improvement during our inspection in December 2016 was as follows:

• Formalise the system for checking the monitoring of high risk medicines ensuring all patients receiving high risk medicines are monitored appropriately and within recommended timescales.

This inspection was an announced focused inspection carried out on 24 July 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 on our previous inspection on 13 December 2016. This report covers our findings in relation to those requirements.

Overall the practice is now rated as good.

Our focused inspection on 24 July 2017 showed that improvements had been made and our key findings across the areas we inspected were as follows:

• The provider had a cohesive procedure in place to ensure that effective monitoring of high risk medicine was carried out.

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 Orford Lodge Surgery on 13 December 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed, with the exception of those relating to periodic reviews of high risk medicines. We found that systems in place for managing the routine monitoring of medication did not ensure reviews were completed as intended.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• Feedback from patients about their care was consistently positive. For example, 100% of patients said they had confidence and trust in the last nurse they saw or spoke to.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. For example, 97% of patients said the last GP they saw was good at listening to them.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider must make improvement are:

• Formalise the system for checking the monitoring of high risk medicines ensuring all patients receiving high risk medicines are monitored appropriately and within recommended timescales.

The practice had the following outstanding features:

• The practice provided dedicated GP services to residents at a homeless hostel, they had provided specialist awareness training for staff, offered flexible appointments and worked in collaboration with other services.
• The practice conducted weekly meetings to review patients who did not attend (DNA) for their appointments. These reviews were linked to safeguarding registers and multiagency information sharing protocols.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice