Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beeches Surgery on 16 May 2017. We carried out this inspection to check that the practice was meeting regulations.

Our comprehensive inspection carried out on 13 January 2015 found concerns including not having appropriate arrangements in place for processing prescriptions, inadequate systems for the reduction of healthcare associated infection control processes, inadequate systems to safeguard patients from abuse and poor leadership structures, and the practice was rated as inadequate and placed into special measures.

When we re-inspected on 19 November 2015 we found that the practice had made significant improvements. However there were still two breaches of regulations concerning recruitment checks and managing risks.

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

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
• Risks to patients were assessed and well managed.
• Recruitment checks had taken place, but had not all been fully documented.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally in line with the national average, and the practice had taken action to improve indicators where performance was weak. Some exception rates were above average, although the overall exception rate was low.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• There was evidence of appraisals and personal development plans for all staff.
• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Care plans were inconsistently completed, and some dementia care plans had insufficient detail recorded to be considered as an adequate care plan.
• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice had identified 32 patients as carers (0.5% of the practice list).
• Since the last inspection, the practice had installed a new phone system with more incoming lines and call waiting information.
• People told us on the day of the inspection that they were able to get urgent appointments when they needed them, but told us of waits of 2 – 3 weeks for routine appointments (longer for particular GPs). The practice told us that they were keeping the situation under review and had various plans underway to improve appointment access.
• Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised, although national guidance on written responses was not consistently followed.
• The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
• There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
• There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
• The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
• There was a strong focus on continuous learning and improvement at all levels.

However, there were also areas of practice where the provider should still make improvements.

The provider should:

• Ensure that all recruitment checks are documented.
• Monitor QOF exception rates and take action to ensure that patients are only excepted appropriately.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Monitor the updated complaints policy to ensure it is effective.

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 Beeches Surgery on 19 November 2015. Overall the practice is rated as requires improvement.

We carried out this inspection to check that the practice was meeting regulations. Our previous comprehensive inspection carried out in January 2015 found breaches of regulations relating to the safe, effective and well led domains. Improvements were also required for responsive and caring domains. Concerns included not having appropriate arrangements in place for processing prescriptions, inadequate systems for the reduction of healthcare associated infection control processes, inadequate systems to safeguard patients from abuse and poor leadership structures.

In addition all population groups were rated as inadequate due to the concerns found in safe, effective and well led. The overall rating from this inspection in January 2015 was inadequate and the practice was placed into special measures for six months.

Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

The inspection carried out on 19 November 2015 found that the practice had made significant improvements and they were meeting some regulations they were previously in breach of. However we identified two breaches of regulations on this inspection.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations were thorough enough.
• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks and fire risks.
• Urgent appointments were usually available on the day they were requested.
• Access to the practice was limited due to an inadequate telephone system that could not manage patient demands effectively.
• The practice had a number of policies and procedures to govern activity
• The practice had proactively sought feedback from patients and had an active patient participation group.
• 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 was available.
• Patients knew how to complain and information was readily available.
• The practice had facilities and was equipped to treat patients and meet their needs although access for wheel chair users was limited.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff including carrying out disclosure and barring services checks prior to employment.

• Ensure an appropriate fire risk assessment is carried out.

In addition the provider should:

• Review arrangements for wheelchair users accessing the building by ensuring they have appropriate facilities to alert staff they require assistance to enter the building.

• Review the availability of an alarm in the disabled accessible toilet ensuring patients are able to alert staff if they need assistance.

• Review the induction process and ensure it covers all relevant areas specific to individual roles.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

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 Beeches Surgery on 16 May 2017. We carried out this inspection to check that the practice was meeting regulations.

Our comprehensive inspection carried out on 13 January 2015 found concerns including not having appropriate arrangements in place for processing prescriptions, inadequate systems for the reduction of healthcare associated infection control processes, inadequate systems to safeguard patients from abuse and poor leadership structures, and the practice was rated as inadequate and placed into special measures.

When we re-inspected on 19 November 2015 we found that the practice had made significant improvements. However there were still two breaches of regulations concerning recruitment checks and managing risks.

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

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
• Risks to patients were assessed and well managed.
• Recruitment checks had taken place, but had not all been fully documented.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally in line with the national average, and the practice had taken action to improve indicators where performance was weak. Some exception rates were above average, although the overall exception rate was low.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• There was evidence of appraisals and personal development plans for all staff.
• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Care plans were inconsistently completed, and some dementia care plans had insufficient detail recorded to be considered as an adequate care plan.
• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice had identified 32 patients as carers (0.5% of the practice list).
• Since the last inspection, the practice had installed a new phone system with more incoming lines and call waiting information.
• People told us on the day of the inspection that they were able to get urgent appointments when they needed them, but told us of waits of 2 – 3 weeks for routine appointments (longer for particular GPs). The practice told us that they were keeping the situation under review and had various plans underway to improve appointment access.
• Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised, although national guidance on written responses was not consistently followed.
• The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
• There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
• There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
• The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
• There was a strong focus on continuous learning and improvement at all levels.

However, there were also areas of practice where the provider should still make improvements.

The provider should:

• Ensure that all recruitment checks are documented.
• Monitor QOF exception rates and take action to ensure that patients are only excepted appropriately.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Monitor the updated complaints policy to ensure it is effective.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice