Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Old Catton Medical Practice 55 Lodge Lane, Old Catton, Norwich, NR6 7HQ Tel: 01603415519 Date of Inspection: 21 February 2014 Date of Publication: March 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Staffing Supporting workers Met this standard Met this standard Met this standard Met this standard Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Old Catton Medical Practice Dr. Robert Keane Old Catton Medical Practice provides general medical services for the geographical area of Old Catton,parts of Spixworth, Sprowston, Hellesdon and northern Norwich. Type of services Regulated activities Doctors consultation service Doctors treatment service Diagnostic and screening procedures Family planning Maternity and midwifery services Surgical procedures Treatment of disease, disorder or injury Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Staffing 10 Supporting workers 11 About CQC Inspections 13 How we define our judgements 14 Glossary of terms we use in this report 16 Contact us 18 Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an announced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 21 February 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff. What people told us and what we found People we spoke with were generally satisfied with the service they received. Some people expressed opinions about the changes that the practice had gone through over the last few years but told us that things 'appeared to be getting better'. One person told us "I telephoned this morning for an appointment. I was telephone triaged which I think is great and I was in to see the doctor within two hours, even better." They went on to say "The nurses are brilliant and the reception staff are usually okay, though the doctors can vary depending on who you get to see." Of the seven people we spoke with, three people expressed the view that doctors could be more understanding on occasion. Most of the people we spoke with had telephoned in that morning to see a doctor. All said getting an appointment was now much easier than it used to be. Another person we spoke with had a pre-booked appointment. They said they sometimes find they can wait a long time in the waiting room before seeing the doctor. Most of the people we spoke with said that they felt listened to and that they were treated with respect and dignity. They told us appointments were usually thorough, that the doctor took time to explain things, that they were of sufficient length and not rushed. The practice building was easy to access with ample parking. All windows facing public areas had blinds and privacy glass. There was a toilet accessible to people with disabilities on the ground floor. You can see our judgements on the front page of this report. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 4
More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 5
Our judgements for each standard inspected Respecting and involving people who use services Met this standard People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. Reasons for our judgement During our inspection we spoke with seven people at the practice whilst they were waiting for their appointments. One person we spoke with was attending with their grand-child. They said "I was asked to bring my grand-child in as mum was going to work. It's not my practice but I was impressed with how quick we got an appointment. Mind you, we have been in the waiting room a long time. But then, they [reception] did say we may have to wait a while. As a visitor to the practice I'm impressed". Another person we spoke with said, "The longest I have had to wait is about thirty minutes. I like to see the same doctor but they always run late, perhaps because they take time and doesn't rush their patients. So I don't mind really". They went on to say that they have confidence in their doctor saying "they are always polite and caring, helpful too". The provider may wish to note that some people spoken with said they didn't feel listened to on occasions which had made them feel isolated. Another person said "I don't care how they [doctors] come across. I'm not here to socialise, I'm here to get better. As long as I get good care that's all I'm interested in". All people we spoke with spoke very highly of the nursing team. One person said "I can engage with them easily, they listen and explain things. They are a real asset to this practice". We noted the receptionist dealt with patients and other visitors to the practice in a polite and courteous manner. We also observed how telephone calls into and out of the practice were both polite and efficient. We noted that discussions between doctor and patient involved discussing options and choices. Efforts were made to re-assure patients and involve them in discussions about their health. We also observed that doctors relayed what to expect next to their patients, and when. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 6
We saw efforts had been made to ensure privacy and dignity in the treatment rooms and we noted that all staff knocked before entering a room. There was also an option offered to use a treatment room as opposed to the doctor's room if more privacy was needed. Both doctors' and treatment rooms had blinds fitted for privacy purposes and some windows also had privacy glass fitted. During our inspection we found that all staff who had patient contact were respectful and courteous. We reviewed the findings of the national 2013 patient survey. The practice manager confirmed that improvements were still needed and we noted that action plans were in place to encourage more involvement with patients. We noted that the practice was in early discussions to re-establish the patient participation group (PPG) and new patient surveys were to be launched once final discussions within the practice had taken place. We also noted continuing patient feedback forms were being collected. Our findings showed that the practice was taking reasonable steps to treat its patients with respect although there were improvements to be made. It involved its patients in decisions about their health and took reasonable steps to keep its patients and staff informed and free from harm. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 7
Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement During our inspection we spoke with seven people who were waiting to be seen. Comments were mixed. One person told us, "I have no reason to complain about the care I get but the service can be variable." Another person told us, "One doctor I can trust, I know I can talk about anything in confidence with them." They went on to say that sometimes they saw different doctors and then the care varied. However, they added "really I have nothing to complain about, it's all okay and let's face it, the practice has had its own challenges lately". One person we spoke with said that care and treatment " can vary " but did go on to say " I'm fully engaged with the doctor. I believe they do their best for me. The practice has been very helpful and put me at ease". Everyone we spoke with said they felt confident that the doctors and staff knew what they were doing and handled information about them in a safe and secure manner. The above told us that the practice took great care to ensure the comfort, welfare and safety of its patients. We reviewed a typical consultation process. The patient's past medical history and current health issues were established prior to the consultation by reviewing the practice's computer system. Likewise current medications and referrals, if any, were reviewed. Patients were then welcomed to the surgery and double checks done as regards identity. One doctor told us "I believe in building good relationships with my patients. I like to understand the family context if I can". This told us that the practice took relevant steps to build a strong and meaningful relationship with its patients. From thank you cards we noted one patient had said of the practice "Thank you for the professional care and kind consideration shown to me over the last two years". Another had said "Can I thank you all for helping me out with my tablets". We also reviewed the paper and computer medical records of five patients in the practice. We cross referenced information on the paper record to that on the computer system. We found all to be correct and timely. We then reviewed the journal relating to each patient Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 8
and studied letters to other health related professionals and the patient themselves. We followed through on diabetic, dermatology, psychiatric and cancer referrals. We found all to contain relevant information such as medical background, current and related medical conditions as well as current medication. All record entries were timely and informative so that other professionals would be clear about people's health and welfare. We noted that the nurse's treatment room was equipped with emergency equipment, for example, cardiac resuscitation equipment, adult and paediatric oxygen masks and an emergency respiratory kit. This told us that the practice was well equipped to deal with a medical emergency. The practice's treatment room was fully equipped to cater for minor procedures and injections. There were ample surgical consumables, hand sanitizers and health and safety notices. There was a locked fridge with a corresponding up to date and signed fridge log. We observed relevant current protocols for example hand hygiene, sharps disposal and urine testing. This told us that the practice took care to ensure that patients could be assured a well-stocked, clean and maintained clinical treatment service. Staff that we spoke with all confirmed that they felt supported in their jobs, had sufficient training to be able to do their jobs and were familiar with the practice policies and procedures. This was confirmed by checking staff records. We found that professional registration for GPs and nurses was current. This told us that the practice took reasonable steps to ensure that the staff were qualified and trained to carry out their jobs and provide safe and effective care. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 9
Staffing Met this standard There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement Old Catton Medical Practice had appointed a fourth doctor in January 2014. It now had a senior partner, a GP prescribing lead, a clinical lead and a part time GP. The practice was supported by a nurse practitioner, senior practice nurse, practice nurse, two health care assistants, a phlebotomist and a practice manager. There was also a supporting business and administration management structure at the practice. To further support the practice there were visiting district nurses, midwives and other healthcare related professionals. We considered that the practice had sufficient suitably qualified and trained staff to run the practice and provide consistency of care. When looking at the staff rotas we noted that the practice had been able to respond to unexpected and changing circumstances, e.g. employees leaving the practice, sickness and long term absence. We also reviewed the business continuity plan for the practice which covered aspects such as significant events and risk management plans which told us the practice took care to ensure staffing levels were appropriate. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 10
Supporting workers Met this standard Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement All GPs were registered with the General Medical Council (GMC) and on the approved GP register. All nurses were registered with the Nursing and Midwifery Council (NMC). This meant that the practice employed suitably qualified doctors and nurses. We reviewed the staff records of five members of staff and found evidence of qualifications, identity, relevant authority checks, references and training. We also reviewed staff appraisals for 2013 which showed date of appraisal, completion date, whether accepted and next review date. We also reviewed induction and training records. All were relevant and up to date. The nurses diary and staff rotas for the period 3 to 21 February 2014 were reviewed and found to be relevant, active and appropriately staffed. Generally we found well-kept and maintained records for staff. However the provider may find it useful to note that some of the staff checklist details, whilst not appearing on the checklist, were indeed in the records. We noted evidence of recent mandatory training in regard to fire awareness dated 28 January 2014. We also saw evidence of health and safety training, basic life support, safeguarding of adults and children. There was a core online learning programme in place. It was noted that the provider was attempting to harmonise training to make it less ad hoc and more timely. The provider had a training matrix which, whilst being reviewed, was current and accurate. This included staff skills, competencies, training and record summary. Elements of training for nurses included infection prevention and control, cytology and equality and diversity as mandatory training. Ad hoc training for nurses included diabetic foot screening, cervical screening and family planning. All were to be scheduled for 2014. We noted similar mandatory and ad hoc training in place for doctors similar to that of nurses. This included nutrition and exercise and insulin management. This told us the practice took relevant steps to ensure its' staff were fully trained and competent to perform their duties. As part of the inspection we spoke with medical secretaries and receptionists. All confirmed they felt supported in their roles and could approach either the doctors or practice manager about training or work related issues. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 11
We found the practice held various meetings, for example reception, practice management and clinical and business. We reviewed the clinical and business meeting minutes for the last three consecutive months. All were found to be self- explanatory and recorded discussion and feedback. This demonstrated that the practice staff were able to regularly participate in dialogue about matters relating to the service. As part of the visit we spoke with front line staff. We sat with the receptionist and saw queries regarding prescriptions being managed, telephone calls being answered and appointments being made. All were done in a professional and caring way. However, the provider may find it helpful to note that on two occasions the receptionist had to explain to patients how and why prescriptions had not been actioned in a timely manner ready for collection. Whilst the receptionist explained and apologised this still meant that people had been inconvenienced. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 12
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 13
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 14
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 15
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 16
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 17
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Old Catton Medical Practice March 2014 www.cqc.org.uk 18