Letter from the Chief Inspector of General Practice

We carried out a focused desktop inspection of Old School Medical Practice on 16 August 2016 to assess whether the practice had made the improvements in providing safe care and services.

We had previously carried out an announced comprehensive inspection of Old School Medical Practice on 19 January 2016, when we rated the practice as good overall. The practice was rated as requires improvement  for providing safe care. This was because the staff had not been provided with appropriate policies and guidance to carry out their roles in a safe and effective manner. Governance systems and processes were not implemented and so monitoring and assessing the whole service in relation to risk and improvements was not evidenced. The infection prevention and control (IPC) policy was in draft and had therefore not been implemented nor was there an up to date IPC audit for both premises. In addition there were areas where the provider should make further improvements.  These included embedding good record keeping in all aspects of dispensing medicines. Comprehensive standard operating procedures (SOPs) which were regularly reviewed required implementation in line with national guidance for dispensing practices. All staff who chaperoned patients required an up to date Disclosure and Barring Service (DBS) check. The dispensary staff's competencies required formal assessment.

We asked the provider to send a report of the changes they had made to comply with the regulations; they were not meeting on the 19 January 2016. In addition we asked for an update of changes made within the dispensary and for verification of up to date DBS checks.

The practice was able to demonstrate that they were meeting the standards and had implemented all changes recommended within the dispensary. We were also provided with up to date DBS disclosures for the appropriate staff.

This report should be read in conjunction with the full inspection report dated 18 March 2016.

Our key findings across the area we inspected was as follows:

There are clearly defined and embedded systems, processes and practices to keep patients safe and safeguarded from abuse.

Staff had received up to date training in systems, processes and practices.

Risks to patients were assessed and well managed.

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 The Old School Medical Practice on 19 January 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 a system in place for reporting and recording significant events. However, we found that some of the systems to keep patients safe had not been implemented effectively.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 there was continuity of care.
• The practice had good facilities and was equipped to treat patients and meet their needs.

• There was a leadership structure and staff felt supported by the management team.

• 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.

We saw one area of outstanding practice:

• One of the GPs had a Post Graduate Certificate in understanding and treating Allergies such as infants with feeding problems and those with allergies. This avoided the need for onward specialist referrals in many cases.

The areas where the provider must make improvement are:

• Take action to address identified concerns with infection prevention and control practice.

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

• Provide staff with appropriate policies and guidance, to carry out their roles in a safe and effective manner, which are reflective of the requirements of the practice.

• Ensure governance systems and processes are implemented to monitor and assess the whole service in relation to risk and improvements.

The areas where the provider should make improvements are:

• Implement comprehensive standard operating procedures (SOPs) which are regularly reviewed in line with national guidance for dispensing practices.

• Embed good record-keeping practices into all aspects of dispensing medicines.

• Regularly assess the competencies of dispensary staff on an ongoing basis.

• Ensure all staff who chaperone have been trained and have an up to date Disclosure and Barring Service (DBS) check.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During the inspection of this practice, we spoke with patients, two doctors who worked at the practice, the practice manager, a practice nurse and reception staff.

We talked to some patients and asked about their experiences when visiting the practice. They told us they were satisfied with the care, support and advice they had received. One patient said “I have been very poorly recently and I have received brilliant care and support from this practice". Another patient said “All the staff are very helpful and kind, nothing is too much trouble."

We observed the experiences of patients who used the service. We saw that staff interacted and communicated well with people. When we looked around the practice we found that it was clean and tidy.

We found that patients were safeguarded against the risk of abuse.

We saw that effective systems were in place to deal with any complaints made about the practice.

The practice was compliant in all of the outcome areas we looked at during this inspection.