Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boxwell Road Surgery on 9 November 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.
• Risks to patients were assessed and managed.

• 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.
• The patients we spoke with or who left comments for us were very positive about the standard of care they received and about staff behaviours. They said staff were friendly, respectful, kind and understanding. They told us that their privacy and dignity was respected and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult and there could be a considerable wait to see a GP when making a pre-bookable appointment. However, those patients said access to urgent and same day appointments was good.
• 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 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 should make improvements are:

• Ensure that systems in relation to patients prescribed higher risk medicines are strengthened to ensure all patients are monitored and reviewed at the required intervals.
• Ensure plans of action to control and resolve risks identified by the health and safety and fire risk assessments are completed.
• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure there is a formal and coordinated practice wide process in place for how staff access guidelines from NICE and use this information to deliver care and treatment.
• Ensure that all staff employed are supported by a formal induction process and by receiving appropriate supervision and appraisal.
• Ensure that a documented policy on patient consent is in place.
• Continue to support carers in its patient population and patients with a learning disability by providing annual health reviews.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).
• Ensure the full written complaints procedure is accessible to patients.
• Ensure that where systems and processes have been recently introduced or re-introduced after considerable gaps, that they are fully embedded and consistently adhered to.
• Take steps to ensure that cross-team communication is comprehensive and maximises opportunities for information sharing and learning in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with four patients face to face, contacted two by email and spoke with five members of staff.

When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient told us: "They explain why and I say yes to them."

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. The patients we spoke with provided positive feedback about their care. A patient told us: "I'm very happy with what they have done for me." Patients received their medicines when they needed them.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to ensure patients were protected from harm.

We found that staff had received appropriate training for the roles they carried out. They also had regular appraisals. This meant that they had been appropriately monitored regarding their competencies.

The provider had a system in place for monitoring the quality of service provision. There was a system to regularly obtain opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.