We carried out an announced comprehensive inspection at Box Surgery on 10 January 2019 as part of our inspection programme. At the previous inspection on 22/06/2016 the practice was rated as good)

We have rated this practice as Requires Improvement overall and good for all population groups.

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.

The key questions are rated as:

• Are services safe? – Requires Impprovement
• Are services effective? – Good
• Are services caring? – Good
• Are services responsive? – Good
• Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Box Surgery on 10 January 2019 as part of our inspection programme.

We rated the safe, effective and well-led domains as requires improvement because:

• There was limited evidence the practice assessed, managed and where appropriate, mitigated risks to patients and staff. For example, there was no evidence the practice had considered any risks that might be inherent with their premises.
• There was no evidence that the risks which had been identified, had been shared with the partners or that appropriate action had been taken.
• There was no evidence the practice had carried out an audit of their infection prevention and control measures since October 2014.
• Shingles vaccines had been given by staff of the practice without patient specific directives being in place.
• The practice had no adequate system or process for ensuring that actions required were monitored or completed in a timely way. There was no evidence that actions which had been agreed were monitored by the partners.

At this inspection we also found:

• In the past 12 months there had been a change in the leadership in the practice which was part of a long-term succession plan.
• In October 2018 the practice suffered a severe flood which tested their resilience and emergency plan. The subsequent renovations had been completed shortly before our inspection.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Feedback from patients indicated a high level of satisfaction. For example, 100% of patients who responded in the most recent national GP survey said they had confidence and trust in the last healthcare professional they saw or spoke.
• 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 areas where the provider must make improvements are:

• The provider must ensure care and treatment is provided in a safe way to patients
• The provider must ensure they have systems or processes established and operated effectively to ensure compliance with their policies and procedures and any regulations which apply.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In March 2016 a comprehensive inspection of Box Surgery, Box, Wiltshire, was conducted. During that inspection we found concerns related to the management of blank prescription security and the systems to monitor this risk. A report setting out the findings of the inspection including the concerns was published in April 2016. Following the inspection the practice sent us an action plan detailing how they would improve on the areas of concern.

We carried out an announced focused inspection of Box Surgery on 22 June 2016 to ensure the changes the practice told us they would make had been implemented and to apply an updated rating.

We found the practice had made significant improvement since our last inspection on 16 March 2016. We have re-rated the practice overall as good. Specifically, they had made improvements to the provision of safe services. The ratings for the practice have been updated to reflect our findings.

At this inspection we found:

• Systems were in place to monitor and ensure the security of blank prescriptions.

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 Box Surgery on 16 March 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 an effective system in place for reporting and recording significant events.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are:

Ensure the system for handling, storing and recording details of blank prescriptions are reviewed and monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice