Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blue Wing Family Doctor Unit on 11 November 2014. The practice was rated as requires improvement for providing safe and caring services and good for providing effective, responsive and well led services. The overall rating for the practice was requires improvement.

We carried out a follow up announced comprehensive inspection on 20 October 2016. The overall rating for the practice was good but required improvement for providing well led services. The full comprehensive reports for 11 November 2014 and 20 October 2016 inspections can be found by selecting the ‘all reports’ link for Blue Wing Family Doctor Unit on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 1 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 20 October 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 good for providing well led services and the overall rating remains as good.

Our key findings were as follows:

• The practice had a clear strategy and business plan to deliver the practice vision and values.
• The practice had developed a systematic programme of quality improvement including audit to assess, monitor and drive improved outcomes for patients.

We also reviewed the actions taken since the last inspection to the areas where we identified the practice should make improvement, some of which we had been addressed.

Our findings were as follows;

• The practice had implemented a written schedule and log for the cleaning of medical equipment.
• Protected time was allocated for nurse administration duties.
• Since our last inspection some improvement had been made to the number of patients the practice had identified and included on the carer’s register which had increased from 38 to 57 patients (0.5% to 0.7% of the practice list size). The practice had implemented additional processes to assist in the identification of patients who were carer’s, including promotion of information about support services available and posters displayed in the waiting area.
• Patient feedback about telephone access to the practice remained an on-going issue. Results from the national GP survey published July 2017 demonstrated that 33% of respondents found it easy to get through to the practice by telephone compared to the CCG average of 70%. This represented a 16% decrease in patient satisfaction of telephone access from the previous national GP survey results published in July 2016. The practice had remained dependent on the telephone hardware available in the building premises up until April 2017 when a new telephone system sourced by the practice had been installed. It was anticipated that the new system would improve patient telephone access experience. Patients were also encouraged to use on-line services to improve access to the practice and 22% of patients had registered for this. 
• Notices informing patients that translation/interpretation services were now displayed in the reception area.
• In addition the practice had considered and implemented the NHS England Accessible Information Standard to ensure that patients received information in formats that they can understand and receive appropriate support to help them to communicate.

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

The provider should:

• Continue to review how carers are identified to ensure information, advice and support is made available to them.

• Continue to monitor patient satisfaction with making appointments.

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 Blue Wing Family Doctor Unit on 20 October 2016. This was to follow up a comprehensive inspection we carried out on 11 November 2014, during which a breach of a legal requirement set out in the Health and Social Care Act (HCSA) 2008 was found: Overall the practice was rated as requires improvement. (The previous report can be accessed by selecting the ‘all reports’ link for Blue Wing Family Doctor Unit on our website at www.cqc.org.uk).

Following a comprehensive inspection of Blue Wing Family Doctor Unit on 11 November 2014 the practice was rated as requires improvement for providing safe and caring services and good for providing effective, responsive and well led services. The practice was given an overall rating of requires improvement. At the inspection shortfalls were identified in relation to criminal reference checks for staff undertaking chaperone duties, completion of clinical audit cycles and patient satisfaction concerning telephone access and some aspects of the care provided. The practice was found to be in breach of one regulation and a requirement notice was set for regulation 21 of the Health and Social Care Act 2008.

After the inspection the practice drew up an action plan to improve its performance in response to the findings of the previous inspection. We then carried out an announced comprehensive inspection at Blue Wing Family Doctor Unit on 20 October 2016 to check that improvements had been made

The practice is rated as requires improvement for providing well-led services and good for providing safe, effective, caring and responsive services. 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 an effective system was in place for reporting and recording significant events.
• Risks to patients were assessed and generally well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they felt the practice offered an excellent service and staff were helpful, caring, polite and responsive and treated them with dignity and respect.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• The practice did not have a formal strategy and supporting business plans which reflected their written vision and values.
• There was a clear leadership structure and staff felt supported by management.
• There was evidence of clinical audit but there was no systematic approach to assess, monitor and improve outcomes for patients.
• 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 improvement are:

• Develop a clear strategy and business plan to deliver the practice vision and values.
• Develop a systematic programme of quality improvement including audit to assess, monitor and drive improved outcomes for patients.

The areas where the provider should make improvement are:

• Implement a written schedule and log for the cleaning of medical equipment.
• Review the current time allocated for nurse administration duties.
• Identify and support more patients who are carers.
• Display notices in the reception areas informing patients that translation services are available.
• Consider negative patient feedback and the actions necessary to improve them.

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 Blue Wing Family Doctor Unit on 11 November 2014. The practice was rated as requires improvement for providing safe and caring services and good for providing effective, responsive and well led services. The overall rating for the practice was requires improvement.

We carried out a follow up announced comprehensive inspection on 20 October 2016. The overall rating for the practice was good but required improvement for providing well led services. The full comprehensive reports for 11 November 2014 and 20 October 2016 inspections can be found by selecting the ‘all reports’ link for Blue Wing Family Doctor Unit on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 1 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 20 October 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 good for providing well led services and the overall rating remains as good.

Our key findings were as follows:

• The practice had a clear strategy and business plan to deliver the practice vision and values.
• The practice had developed a systematic programme of quality improvement including audit to assess, monitor and drive improved outcomes for patients.

We also reviewed the actions taken since the last inspection to the areas where we identified the practice should make improvement, some of which we had been addressed.

Our findings were as follows;

• The practice had implemented a written schedule and log for the cleaning of medical equipment.
• Protected time was allocated for nurse administration duties.
• Since our last inspection some improvement had been made to the number of patients the practice had identified and included on the carer’s register which had increased from 38 to 57 patients (0.5% to 0.7% of the practice list size). The practice had implemented additional processes to assist in the identification of patients who were carer’s, including promotion of information about support services available and posters displayed in the waiting area.
• Patient feedback about telephone access to the practice remained an on-going issue. Results from the national GP survey published July 2017 demonstrated that 33% of respondents found it easy to get through to the practice by telephone compared to the CCG average of 70%. This represented a 16% decrease in patient satisfaction of telephone access from the previous national GP survey results published in July 2016. The practice had remained dependent on the telephone hardware available in the building premises up until April 2017 when a new telephone system sourced by the practice had been installed. It was anticipated that the new system would improve patient telephone access experience. Patients were also encouraged to use on-line services to improve access to the practice and 22% of patients had registered for this. 
• Notices informing patients that translation/interpretation services were now displayed in the reception area.
• In addition the practice had considered and implemented the NHS England Accessible Information Standard to ensure that patients received information in formats that they can understand and receive appropriate support to help them to communicate.

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

The provider should:

• Continue to review how carers are identified to ensure information, advice and support is made available to them.

• Continue to monitor patient satisfaction with making appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice