This practice is rated as good overall.

At our previous inspection in June 2016, Cherrymead Surgery had an overall rating as Good.

Following the March 2018 inspection, the key questions are rated as:

• Are services safe? – Good

• Are services effective? – Good

• Are services caring? – Good

• Are services responsive? – Good

• Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – Good

• People with long-term conditions – Good

• Families, children and young people – Good

• Working age people (including those recently retired and students – Good

• People whose circumstances may make them vulnerable – Good

• People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Cherrymead Surgery in Loudwater, Buckinghamshire on 6 March 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. Furthermore, this inspection was also in response to information of concern regarding safeguarding and recruitment arrangements. These concerns were shared by the practice and received by the Care Quality Commission in January 2018.

At this inspection we found:

• Cherrymead surgery had clear systems to keep patients safe and safeguarded from abuse.
• Recruitment procedures were not always undertaken in line with schedule three of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• The practice conducted safety risk assessments. Policies were accessible to all staff and they outlined clearly who to go to for further guidance.
• There was an effective system to manage infection prevention and control.
• Staff understood their responsibilities to manage emergencies on the premises and to recognise those in need of urgent medical attention.
• Staff had the information they needed to deliver safe care and treatment to patients.
• The practice learned from and made improvements when things went wrong.
• Cherrymead Surgery was part of a local GP Development Scheme with a commitment to care and support planning for patients with long-term conditions.
• Patients had access to appropriate health assessments and checks. The practice specifically considered the physical health needs of patients with poor mental health and those living with dementia.
• The most recent published Quality Outcome Framework (QOF) results showed the practice were comparable with local and national achievements.
• The practice supported patients to live healthier lives through a consistent, targeted and proactive approach to health promotion and prevention of ill health.
• Staff treated patients with kindness, respect and compassion.
• Written and verbal patient feedback commented practice staff gave patients timely support and information.
• Staff supported patients to be involved in decisions about their care.
• The practice organised and delivered services to meet patients’ needs and took account of patient needs and preferences.
• Results from the July 2017 annual national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was similar when compared to local and national averages, with some areas of significantly higher than average levels of patient satisfaction.
• The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.
• Leaders had the capacity and skills to deliver high-quality, sustainable care.
• The practice had a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.
• The processes for managing risks, issues and performance were operated appropriately.
• The practice involved patients, the public, staff and external partners to support high-quality sustainable services.
• There were systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvement as they are in breach of regulations is:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 Cherrymead Surgery in Loudwater, High Wycombe on 14 June 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Feedback from patients about access to appointments was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient groups. Recent examples included current “live” wait times displayed on TV screens within the waiting areas.

• The practice had good modern facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The practice worked with the patient participation group (PPG) to organise patient education meetings. These were held at the practice and were open to any patient who wished to attend. Recent topics covered included Alzheimer’s disease and dementia. We also saw information following an education session about strokes delievered by the Stroke Association. We were told these education meetings were very well attended with over 60 patients and their carers attended. We saw plans for a further meeting in autumn 2016 educating patients on diabetes and diabetes related complications.

However there were areas of practice where the provider should make improvements:

• Review and address the low GP national patient satisfaction scores for consultations with Cherrymead Surgery GPs.

• Increase the promotion and raise patient awareness of the revised appointment process.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Patients told us they were treated with care, dignity and respect. We saw staff spoke with patients in a professional and friendly manner both on the telephone and in person at the practice. One patient told us “I feel well respected and we all get treated on an equal basis.” Another patient commented “…Always willing to listen to whatever I have to say even if I go on a bit.” A third patient commented “I attend in a wheelchair and so can feel patronised by some people. I have never felt patronised by any of the practice staff, who always offer support without pity.” This meant patients were treated with dignity and respect.

Patient’s we spoke with told us that they were satisfied with the care and treatment they had received from the staff at Cherrymead Surgery. One patient described the practice as “Brilliant” and told us “It’s the best surgery I have ever been to.” Another patient told us “I love the doctors.”

We found that patients were protected from abuse and harm because the provider had taken suitable steps to ensure staff could respond appropriately should abuse be suspected or alleged.

Patients were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found patients were made aware of the complaints system. Patients we spoke with did not express any concern about the care and treatment they had received. They told us they felt confident and comfortable to make a complaint.

We carried out an announced comprehensive inspection at Cherrymead Surgery on 6 March 2018 as part of our inspection programme. The practice was rated as good overall and requires improvement in well-led.

This focused follow up inspection was to follow up the concerns identified in well-led. The practice is now rated as good overall and in well-led.

We concluded that:

• There were clear responsibilities, roles and systems of accountability to support good governance and management.

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

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