Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Beech House Surgery on 25 April 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Beech House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 October 2017 to confirm that the practice had carried out their plan to make the improvements that we identified in our previous inspection on 25 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for providing safe services; overall the practice rating remains good

Our key findings were as follows:

• The process for managing repeat prescriptions was embedded in the practice. All requests for repeat prescriptions were directed to the duty doctor before being sent to the dispensary or reception for collection. All repeat prescription requests were dealt with on the day and were monitored to ensure that none had been left unattended to at the end of the day.

• PGDs and PSDs were all signed and up to date. PGDs were reviewed on a three monthly basis to ensure all were in date and action was taken regarding any that were due to expire within the three month period.

• An identified nurse had now completed the specialist course on infection, prevention and control. There was a quarterly walkthrough audit undertaken and a comprehensive annual audit each February. Legionella risks were managed by the practice and training had been provided by an external provider.

• A new door lock with a key pad had been placed on the access door to the paper medical records ensuring security could be maintained.

• Music was now piped into the waiting area outside the nurses’ room reducing the risks of breach of confidentiality from conversations being overheard.

• The practice had a comprehensive training matrix identifying all training completed and due dates.

• There was an appraisal system that included assessing competencies and the HCAs were observed a minimum of three times a year by the nurse to ensure competencies were maintained.

• Clinical and non-clinical alerts were received into the practice via a surgery email address as well as the practice manager to ensure that in the absence of the practice manager alerts would be dealt with by a nominated person.

• GP letters were monitored bi-weekly to ensure that all letters had been dealt with by the GPs. Any GPs with unattended letters were alerted to this by the practice manager.

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 Beech House Surgery on 25 April 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a new system in place for reporting and recording significant events.
• The practice mostly had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Risks to patients were mostly assessed and managed in a timely way which resulted in some areas that required improvement.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients said they could access appointments in a timely way. The practice had responded to feedback regarding appointments and had recently introduced changes to improve appointment availability.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• There was an overarching governance framework which supported the delivery of the strategy and good quality care. We identified some areas that required improvement and further oversight and many initiatives that were in their infancy that needed to be embedded moving forward. Despite this, it was evident from the partners and practice manager we met that they had experience, capacity, committment and capability to run the practice to deliver these improvements .
• The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty.
• The practice proactively sought feedback from staff, patients and attached staff, which it acted on.
• The patient participation group (PPG) was extremely active and committed.

We saw two areas of outstanding practice:

• The PPG was a well structured, active and committed. Their work clearly benefited patients and the practice.
• The practice's case management of vulnerable people.

The areas where the provider should make improvement are:

• Monitor the new process of signing repeat prescriptions before they are issued to patients. This is in order to demonstrate these improvements become embedded into practise in the long term.
• Ensure all the patient group directions (PGDs) and patient specific prescription (PSDs) are up to date and used appropriately.
• Monitor the improved infection control arrangements. This is in order to demonstrate these improvements become embedded into practise in the long term.
• Monitor the new secured access to patients paper records.
• Address the confidentiality of patient conversations outside of the nurses rooms.
• Ensure that systems are in place so the practice has full oversight of staff training completed, due and outstanding.
• Ensure arrangements are in place for the health care assistants (HCA) competencies to be formally assessed.
• Ensure systems are in place so the practice has full oversight of both clinical and non-clinical alerts received by the practice.
• Ensure systems are in place to monitor the allocation, actioning and follow up of letters received into the practice that are allocated to GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice