We carried out a comprehensive inspection of Chalgrove and Watlington Surgeries in October 2018. The practice was rated good overall but had breached a regulation resulting in a rating of requires improvement for providing safe services.

Subsequent to the October 2018 inspection our inspection and monitoring system changed and we carried out an annual regulatory review on 3 May 2019 and reached a decision to follow up the breach of regulation with a focused inspection. This inspection was carried out on 15 May 2019 when we found the practice had addressed the issues that gave rise to the breach of regulation. We have therefore updated the rating of provision of safe services to good and the practice remains rated good overall.

At the focused inspection on 15 May 2019 we specifically found:

• The practice had ensured separation of specimens awaiting collection from medicines requiring refrigeration by installing specimen holding refrigerators.
• The management of the cold chain for medicines requiring refrigeration had improved. Systems in place ensured that any interruption to the cold chain were reported and dealt with immediately they were identified.
• The system enabling nurses to administer vaccines and other medicines without individual prescriptions was meeting legal requirements.

Details of our findings and the evidence supporting the change in rating are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Good overall. (Previous rating November 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Chalgrove and Watlington Surgeries on 15 October 2018 as part of our inspection programme.

At this inspection we found:

• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. The practice provided a responsive appointment system that resulted in short waits for both urgent appointments and appointments booked in advance.
• The practice worked closely with local charities and community organisations to encourage patients to access social and support networks when it was appropriate to do so.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Patient feedback about the services offered was consistently positive.
• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, monitoring of safety had not identified that the cold chain policy, in place to maintain medicines at appropriate temperatures, had not always been followed. Also, the practice had not completed the necessary authorisation for all nurses to administer vaccines without the need for individual prescriptions.

The area where the provider must make improvement is:

• Ensure care and treatment is provided in a safe way to patients

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chalgrove and Watlington Surgeries on 3 November 2015. 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 well 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.
• Patient care was effectively monitored in order to drive improvement.
• 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 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.

We saw one area of outstanding practice:

The response to the GP national survey showed patients were significantly more satisfied with how they were treated by staff at the practice when compared to the local and national average. For example:

• 99% said the last GP they saw was good at explaining tests and treatments compared to the CCG average of 89% and national average of 86%.
• 96% said the last GP they saw was good at involving them in decisions about their care
• 98% said the GP was good at listening to them compared to the CCG average of 91% and national average of 89%.
• 96% said the GP gave them enough time compared to the local average of 89% and higher than the national average of 87%.
• 100% said they had confidence and trust in the last GP they saw compared to the CCG average of 97% and national average of 95%

There are areas where the provider should make improvements:

• Assess and mitigate any risks related to the storage of prescription pads in nurses rooms.

• Identify all patients on long term medicines on new the patient records system to ensure they have their medication reviews recorded accurately.

• Review the ability for hearing impaired patients to be able to access the practice independently, via installation of hearing aid loops.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to Chalgrove and Watlington Surgeries we met with the senior GP partner and the practice manager. We spoke with seven patients, five in person and two by telephone. We also spoke with three members of staff.

Patients were able to access services via appointments that met their needs. One patient said "getting appointments is absolutely fine and if there is a genuine need [to be seen urgently] they will fit you in".

Patients received services that were planned and delivered in a way to ensure their welfare. One patient told us "I always get a medicines review and they call me in for annual check ups".

Some guidance relating to reducing the risk of infection was not being followed. The provider had not reviewed their infection control procedures and a legionella risk assessment had not been completed in line with Health and Safety Executive guidance.

Staff were well supported and received training appropriate to their roles and responsibilities. For example, a practice nurse had taken specialist training in the care of patients with Asthma.

There were systems in place to seek and act upon patient views. Annual patient satisfaction surveys were carried out and a patient participation group was active, meeting once every two months.