We carried out an announced comprehensive inspection at Sheringham Medical Practice on 9 January 2018. The overall rating for the practice was good, with a requires improvement rating for providing safe services. We issued a requirement notice against regulation 17 as there were out of date emergency medicines and consumables in the practice and the process in place for the management of patient safety alerts was not effective.

We also identified areas the practice could improve including documentation relating to children who did not attend appointments, and the system for managing patients with diabetes during and following pregnancy.

The full comprehensive report on the January 2018 inspection can be found by selecting the ‘all reports’ link for Sheringham Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 August 2018 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 9 January 2018.

This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is now rated as good, with a good rating for providing safe services.

At this inspection we found:

• The practice had carried out a comprehensive review of safeguarding systems and processes and implemented changes to the way missed appointments are assessed and recorded for children and vulnerable patients.
• The practice had reviewed and implemented a robust new process for checking and recording emergency medicines and equipment.
• Processes for receiving, reviewing, acting on and monitoring safety alerts had been reviewed and improvements made.
• The process for managing diabetes during and after pregnancy had been thoroughly reviewed and systems put in place to improve identification, monitoring and recording of patients with diabetes during pregnancy and following pregnancy.

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.

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection December 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 Sheringham Medical Practice on 09 January 2018 as part of our inspection programme.

At this inspection we found:

• The practice had risk assessments in place to reduce the risk to patients. When incidents did happen, the practice learned from them and improved their processes.

• The practice had systems to safeguard children and vulnerable adults from abuse. The practice told us they followed up that had children not brought to appointments; however documentation in clinical notes did not always support this.

• There was a system to manage infection prevention and control (IPC).

• We found medicines and some other items on the emergency trolley to be out of date. These were removed immediately.

• Significant events and complaints were well managed in the practice. The practice kept an overall log of significant events and complaints.

• There was a system for receiving and acting on safety alerts. In the dispensary, there was a clear system and log of events and actions such as alerts relating to recall of medicines. However, the documentation of the alerts that were managed by the GPs and management team did not clearly evidence that actions had been taken.

• The system for the follow up of patients that had diabetes in pregnancy was ineffective and did not always evidence a review of patients after pregnancy.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided and had completed 29 clinical and non-clinical audits. It ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice achieved 99.9% of available points within the Quality and Outcomes Framework.

• Staff involved and treated patients with compassion, kindness, dignity and respect. Patients we spoke with reflected this view, as did the CQC comment cards.

• The practice were above or in line with local and national averages for the GP patient survey questions relating to access.

• The practice held many informative days for patients on areas such as cancer, carers and dementia. All staff were trained in dementia awareness.

• There was a strong focus on continuous learning and improvement at all levels of the organisation and the practice were keen, where possible, to upskill staff.

The areas where the provider must make improvements 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:

• Review and improve the documentation in clinical notes for children that were not brought to appointments.

• Review and improve the system for the management of patients that had diabetes in pregnancy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice