We carried out an announced focused inspection at A J Cole and partners on 12 December 2018.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 20 March 2018.

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 rated the practice as good for providing safe services because:

• The practice had taken account of our findings at the last inspection and made improvements to systems and processes to keep patients safe.
• Staff training had been improved and staff had received up-to-date safety training appropriate to their role.
• Systems to ensure the safe storage of medicines requiring refrigeration had been reviewed and improved.
• The practice was clean and tidy and systems to prevent, and control the spread of infections had been reviewed and improved.

Additionally, we found:

• The practice had considered recently published data and had reviewed the effectiveness and appropriateness of care for diabetes patients.
• They had developed a duty of candour policy and procedure as recommended at the last inspection.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection June 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at A J Cole and Partners on 20 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, there was a lack of records to evidence all staff had received up-to-date safety training appropriate to their role.
• There were systems in place for safe management of medicines however, there were some shortfalls in the storage of vaccines.
• The practice was clean and tidy but there were some shortfalls in systems to prevent, and control the spread of infections.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it although some people said there was a wait to see a GP of their choice. The practice had continually reviewed and adjusted the appointment system.
• There was a focus on continuous learning and improvement at all levels of the organisation.

We observed one area of outstanding practice:

The practice was proactive in monitoring prescribing in the practice and had worked closely with the clinical commissioning group (CCG) pharmacist and employed a practice pharmacist to drive improvements in this area. Data provided showed year on year improvement across all the areas monitored by the CCG. The practice had also identified issues relating to over ordering of medicines by third parties and had been the first practice in Rotherham to take part in audits to assess related processes. Following improvements made as a result of the audits they had successfully reduced their prescribing budget by 10% and evidence of further reductions for the year to date were also seen. The process for improvement had been rolled out across Rotherham.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients (for details of the breach please see the requirement notice at the end of this report).

The areas where the provider should make improvements are:

• Review the practice protocol for the management of letters received into the practice and share this with staff responsible for related tasks.

• Consider developing a written policy and procedure and central action log to support the management of alerts.

• Develop a written duty of candour policy and procedure.

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 A J Cole and Partners on 9 June 2015. The practice achieved an overall rating as good.

Specifically, we rated the practice as good for providing safe, effective, caring, responsive and well-led services and care for all of the population groups of people it serves.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

We found areas of outstanding practice:

• The practice had a robust unplanned hospital admission system where high risk patients were identified and intensive support was provided, which included education, individualised care planning and referral to other health and social care services and voluntary organisations.
• The practice advised and supported relevant diabetic patients to manage their condition during the period of Ramadan.
• The practice offered extended hours appointments from 7am three mornings per week.
• The practice had colour-coding in rooms and corridors which supported patients to find their way to consulting rooms, treatment rooms and toilets.

However, there was an area of practice where the provider should make improvements:

• Ensure all disposable curtains in consulting and treatment rooms are dated and changed in accordance with infection prevention and control guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice