Orchard Surgery

Updated 4 April 2022

• The name of the registered provider is Orchard Surgery. The address of the location is New Road, Melbourn, Royston, Hertfordshire, SG8 6BX.
• The practice is registered to provide diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
• Orchard Surgery provides services to approximately 8,200 patients in a semi-rural area.
• The practice has five GP partners (three female, two male) and one salaried GP (female). There is a management team including a practice manager and an assistant practice manager. They are supported by a team of reception and administration staff. The practice employs three practice nurses (including a lead nurse), two healthcare assistants, a phlebotomist and a pharmacist who is employed via the Primary Care Network. There is a lead dispenser and a team of dispensary staff.
• The practice holds a General Medical Services contract with NHS England. The practice is able to offer dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy. We visited the dispensary as part of this inspection.
• The practice is open between 8.30am and 6pm Monday to Friday. Urgent appointments are available for people that need them. Online appointments are available to book in advance.
• When the practice is closed patients are automatically diverted to the GP out of hours service provided by Herts Urgent Care. Patients can also access advice via the NHS 111 service.
• The practice has a below average number of patients aged 15 to 39 compared to the CCG average, and an above average number of patients aged 50 to 84 compared to the national and CCG average. Male and female life expectancy in this area is in line with the England average at 82 years for men and 85 years for women. The practice was in the lowest decile for deprivation.
• Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance, most GP appointments were telephone consultations. If the GP needs to see a patient face-to-face then this option is available.

Updated 4 April 2022

We carried out an announced focused inspection at Orchard Surgery on 9 March 2022. Overall, the practice is rated as Good.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Peterborough and Cambridge. To understand the experience of GP providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

We inspected three key questions and rated them as follows:

Safe - Good

Effective - Good

Well-led – Good

Previously, we carried out an announced focused inspection at Orchard Surgery on 12 February 2020, looking at the key questions of Safe, Effective and Well-led. We decided to undertake this inspection following our annual review of the information available to us. At this inspection, the practice was rated Good overall, Good for providing Effective services, Good for providing Well-led services and Requires Improvement for providing Safe services, including a breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Orchard Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused follow-up inspection to follow up on the breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment at the previous inspection on 12 February 2020. We inspected the key questions, Safe, Effective and Well-led. We also looked at whether the provider had acted on the areas where we advised they should improve.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short site visit
• Staff feedback questionnaires via email.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

• The requirement notice had been adequately addressed.
• The provider had acted on the areas where we advised they should improve.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

At this inspection, whilst we found no breaches of regulations, the provider should:

• Review and improve the system for receiving, reviewing and acting on safety alerts to minimise the risk of patients being put at risk.
• Ensure clinical staff complete safeguarding training in a timely manner in line with national guidance.
• Continue to monitor and improve the prescribing rates for antimicrobials.
• Extend the review of Do Not Attempt Cardiopulmonary Resuscitation decisions , (DNACPR) and documentation, to include those carried out by community healthcare professionals.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care