Frithwood Surgery

Updated 9 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 28 January 2016. During our inspection we found a breach of legal requirements relating to the management of medicines. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to meet Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 Safe care and treatment.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements and should be read in conjunction with the full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Frithwood Surgery on our website at www.cqc.org.uk

We found the practice had made improvements since our last inspection on 28 January 2016 and they were meeting the regulation relating to the management of medicines that had previously been breached.

Specifically the practice was operating safe systems in relation to the management of medicines. This included:

• Ensuring the temperature of vaccine fridges were adequately recorded and monitored.
• Systems to monitor the use of handwritten prescription forms.
• Ensuring patient group directions were signed by a person authorised by the practice.
• In addition, the practice now ensures that internal management checks of controlled drugs are undertaken.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2016

The practice is rated as good for the care of patients with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice achieved 91% of the targets for care of patients with diabetes in 2014/15 which was below the clinical commissioning group average of 95% and above the national average of 89%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 22 March 2016

The practice is rated as good for the care of families, children and young patients.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 74% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months (04/2014 to 03/2015) compared to the national average of 75%.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years (04/2014 to 03/2015) was 83% which was comparable to the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses. For example, the practice held weekly primary healthcare team meetings to share information and discuss patients at risks.

Updated 22 March 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• There was a lead nurse for patients over the age of 75 who contacted patients to ensure that their health and social needs were being met. The nurse would also administer flu vaccines to elderly patients unable to attend the practice.

• The practice held weekly multi-disciplinary meeting and the needs of older patients as well as those at risks were discussed. The number of patients on the practice’s palliative care register who have had a review was 100%.

Updated 22 March 2016

The practice is rated as good for the care of working-age patients (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Extended hours were available from 7.30am to 8am on Thursday mornings and 6.30pm to 7pm on Wednesday and Thursday evenings.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 22 March 2016

The practice is rated as good for the care of patients experiencing poor mental health (including people living with dementia).

• 97% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was above the national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015), was 100% compared to the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those diagnosed with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 March 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice provided GP services to a local residential unit for young patients.