Mendip Country Practice

Background to this inspection

Updated 1 September 2017

Mendip Country Practice is located in Coleford, near Radstock, Somerset. The practice serves a local, mostly rural population of approximately 5300 patients from the village and surrounding area. The practice participates in the Somerset Practice Quality Scheme (SPQS), instead of QOF, including services under the brand ‘Your Health and Wellbeing Mendip’. The practice operates a dispensary on site and participates in the Dispensary Services Quality Scheme (DSQS).

The address is:

Mendip Country Practice

Church St

Coleford

Radstock,

Somerset

BA3 5NQ

There is parking on site, including spaces for patients with a disability and unrestricted parking on adjacent road. The practice has a number of rooms which it makes available to other services, including Health Connections Mendip.

Mendip County Practice has five GPs, four of whom are partners. Between them they provide 31 GP sessions each week and are equivalent to 3.9 whole time employees (WTE). Three GPs are female and two are male. A new partner had joined the practice in May 2016; however, we had not yet received the required Application to include the partner in the CQC Registration. The provider was reminded of their responsibility to submit the required registration change application to the Care Quality Commission and this was subsequently received.

There are two practice nurses, whose working hours are equivalent to 1.6 WTE, including a non-medical prescriber who offers seven sessions per week. Two health care assistants are also employed by the practice with combined hours of 1.3 WTE. The GPs and nurses are supported by 21 management and administrative staff including a practice manager and a deputy/IT lead. The practice also employs a clinical prescribing pharmacist for two sessions per week.

The practice patient population is expanding and has slightly more patients between the age of 40 and 74 years; and slightly less patients between the age of 20 and 39 years than the national averages. Approximately 22% of the patients are over the age of 65 years compared to a national average of 17%.

Approximately 56% of patients have a long standing health condition compared to a national average of 54%. Patient satisfaction scores are high with 93% of patients describing their overall experience at the practice as good compared to a national average of 85%.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the fourth least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the area is in line with the national average of 79 and 83 years respectively; and for males, is one year less, than the Clinical Commissioning Group average.

The practice is open between 8am and 6.30pm Monday to Friday, with early access from 6.45am on Tuesdays. Appointments are available from 9am and emergency telephone access is available from 8.30am. Extended hours appointments are offered on Tuesdays, from 7am and the practice also offers telephone consultations. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day.

GP appointments are 10 minutes each in length and appointment sessions are typically 9am until 12pm and 2pm until 6pm. Each consultation session has 18 appointment slots. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.

The practice has a General Medical Services (GMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice is a teaching and training practice and three registrar GPs were in placed at the time of our inspection. The practice also hosts placements for medical students. Four of the GPs are GP trainers and this provides training resilience when one of the training partners is away. The practice has opted out of providing out-of-hours services to their own patients. Patients are directed to this service by the practice outside of normal practice hours.

Overall inspection

Good

Updated 1 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Mendip Country Practice on 20 September 2016. The practice was rated as requiring improvement for providing safe services; and was rated as good for providing effective, caring, responsive and well-led services. As a result, the practice was given an overall good rating. Following the comprehensive inspection we issued a requirement, due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) Regulations 2014, relating to safe care and treatment.

Within our last inspection report we stated that the provider must:

Ensure proper and safe management of medicines including arrangements for temperature checks of vaccine storage and action where temperatures are found to be outside the acceptable range.
Ensure patients are kept safe by staff who had a Disclosure and Barring Service (DBS) check to act as chaperones; and arrangements are understood and consistently applied by all staff.

In addition, we stated that the provider should:

Review arrangements to assess areas of ‘near misses’ in the dispensary in order to identify trends and take action to prevent, where possible, future occurrences.
Review health and safety arrangements for use of cryogenic substances.
Review arrangements to ensure all staff receive regular appraisals.

The full comprehensive report on 20 September 2016 inspection can be found by selecting the ‘all reports’ link for Mendip Country Practice on our website at www.cqc.org.uk.

We undertook a focused follow-up inspection of the practice on 8 August 2017. The inspection was to confirm that the practice had implemented its action plan to meet the legal requirements in relation to the regulatory breaches that we identified in our previous inspection on 20 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

There were key findings across all areas we inspected during this follow-up inspection. We saw documentary and other evidence that:

The practice had a record of appropriate actions to be taken if vaccine fridge temperatures were outside the acceptable range.
The practice reviewed its chaperone policy so that only trained staff with a Disclosure and Barring Service (DBS) check would act as patient chaperones. When we spoke to staff who act as chaperones, arrangements were understood and consistently applied.
The practice monitors and records ‘near misses’ in the dispensary in order to identify trends and take action to prevent future occurrences.
A Control of Substances Hazardous to Health (CoSHH) risk assessment was in place for cryogenic substances.
The practice reviewed arrangements to monitor and ensure that all staff received a regular annual appraisal. During our focused follow up inspection, we saw documentary evidence that appraisals for all staff were completed before the end of 2016, or were scheduled for completion in 2017. We saw the practice had a system in place to monitor when appraisals were due.

Following this inspection the practice was rated as good across all domains, and its overall rating remained unchanged.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice