Letter from the Chief Inspector of General Practice

We visited Arbury Road Surgery on the 15 April 2015 and carried out a comprehensive inspection. The overall rating for this practice is good. We found that the practice provided a safe, effective, caring, and responsive service. Improvements were needed to ensure that robust governance process were in place in relation to policies.

We examined patient care across the following population groups: older people; those with long term medical conditions; mothers, babies, children and young people; working age people and those recently retired; people in vulnerable circumstances who may have poor access to primary care; and people experiencing poor mental health. We found that care was tailored appropriately to the individual circumstances and needs of the patients in these groups. Our key findings were as follows:

• All patients at the practice were registered with a named GP and we saw evidence of continuity of care.

• Patients were satisfied with the opening hours. They reported that it was easy to get through on the telephone to make an appointment and appointments were made at convenient times.

• Patients felt they were treated with dignity, care and respect. They were involved in decisions about their care and treatment.

• The practice addressed patients’ needs and worked in partnership with other health and social care services to deliver individualised care.
• The practice had good facilities and was well equipped to treat patient and meet their needs.

• The needs of the practice population were understood and services were offered to meet these. Feedback from the care homes where patients were registered with the practice was positive.

• Staff were clear of their roles and responsibilities and followed available guidance. However improvements were needed to ensure there was a robust process in place for the approval, dissemination and review of policies.

However, there were also areas of practice where the provider needs to make improvements. In addition the provider should:

• Identify areas where oxygen is stored and mark them with 'hazardous substance' notices.
• Ensure the process for checking that identified actions had been undertaken following significant events and complaints is completed and documented.
• Ensure all staff attend infection control training.
• Review and update the disaster recovery plan.
• Ensure all staff receive an annual appraisal.
• Provide information on the complaints policy so that it can be easily and independently accessed by patients.
• Ensure there is a robust process for the approval, dissemination and review of practice policies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection on 28 November 2013 we spoke with 18 people who were either waiting to attend an appointment, or were collecting a prescription for medication. Overall, they told us they were very satisfied with the service provided by the surgery and made comments about the positive and friendly attitude of GPs, the nurses and the reception staff they had spoken with. One family group we spoke with who were attending an appointment said, "They are all polite and helpful. We are lucky to have such a good surgery near to us."

We found that people were well informed and suitably involved in the detail and information they required about their health and in the planning of their healthcare. Care records reflected the health support advice and treatment that had been provided to people.

We found that people were protected from abuse and harm because the provider had taken suitable steps to ensure staff could respond appropriately should abuse be suspected or alleged.

Staff were supported to carry out their roles with competency. Clinical staff had been supported to continue their professional development and GPs had ensured they were able to maintain their professional development and status of a teaching practice approved by the NHS Health Education East of England that supports medical trainees in the region.

This practice is rated as Good overall. At the previous inspection in June 2015 the

practice were rated as good overall.

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

We carried out an announced comprehensive inspection at Arbury Road Surgery on 14 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear 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. We saw evidence that learning points were discussed in management meetings and staff we spoke to were aware of these.
• 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.
• The practice’s performance in relation to the Quality Outcome Framework (QOF) results was in line with the Clinical Commissioning Group (CCG) and national averages.
• The overall exception reporting rate was above the CCG and national averages. We noted that the practice had incorrectly coded some patients’ records, which had led to the patients being incorrectly included in the exception reporting rate.
• The practice’s uptake for cervical screening was below the target for the national screening programme. The practice advised due to the multilingual demographic of the practice population, the practice had difficulties in patients attending for cervical screening due to uncertainty over the procedure. We could not find evidence that the practice had made further engagement with patients of this group to educate and encourage attendance.
• There were comprehensive risk assessments in relation to building safety issues such as fire safety and health and safety.
• The infection prevention and control policy was brief and missing key information such as waste and sharps management.
• The practice employed an external cleaning company, but there was no documentation to evidence the cleaning that took place within the practice. We found on the day of the inspection that the cleanliness of treatment rooms was not to an acceptable standard. We noted there was dirt and dust on the floor in two treatment rooms. This was also highlighted in the audit completed one week prior to our inspection but no action had been taken to remedy this.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff told us that they were happy to work at the practice and felt supported by the management team. Staff told us they were encouraged to raise concerns and share their views.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Results from the July 2017 national GP patient survey were in line with and above local and national averages. Feedback from patients we spoke with and received comments from supported these findings.
• We saw evidence that complaints were handled effectively, trends were analysed and lessons learned and distributed amongst relevant staff.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Review and improve the uptake of cervical screening.
• Review and improve the coding of patient records to ensure reviews are carried out appropriately.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice