Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Lane Surgery on 3 November 2016. The overall rating for the practice was good. However, a breach of the legal requirements was found which resulted in the practice being rated as requires improvement for providing safe services. The full comprehensive report for the November 2016 inspection can be found by selecting the ‘all reports’ link for Church Lane Surgery on our website at www.cqc.org.uk.

In addition to the breach of regulation, at the inspection on 3 November 2016 we also said the practice should consider the following areas:

• Review the arrangements currently in place for revisiting changes introduced by the practice over time to ensure they are effective and embedded within the practice.
• Review the governance arrangements currently in place for monitoring training to ensure the system is effective and affords the management oversight of what training is due to be completed and updated.
• Review the effectiveness of the governance arrangements in place for the recruitment of staff to ensure staff are recruited in a safe and timely way.
• Review the arrangements for supervising dispensing staff to ensure dispensing staff are supervised by a member of staff with detailed knowledge of their role.

This inspection was an announced focused inspection carried out on 5 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulations that we identified in our previous inspection on 3 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had reviewed their arrangements for the management of medicines and these were managed safely.
• We saw that significant events, near misses and changes within the practice were discussed at relevant team meetings and that minutes were made available to all staff.
• The practice had implemented an improved system to monitor staff training, which enabled the management to review and arrange training in a proactive manner.
• The practice had reviewed the arrangements for the recruitment of staff.
• We found that the arrangements for the supervision of dispensary staff were appropriate.

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 Church Lane Surgery on 3 November 2016. Overall the practice is rated as good.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, we found some incidents in the dispensary that had not been reported and or acted on in a timely way.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not always implemented well enough to ensure patients were kept safe. For example we found that medicines were not always safely managed and the recruitment policy not always followed.
• There was a high level of external engagement with the local safeguarding team. Staff were trained in safeguarding adults and children at a level appropriate to their role.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide patients with the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care and treatment was consistently positive. Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care. Staff were motivated and inspired to offer kind and compassionate care.
• Views of external stakeholders were extremely positive and aligned with our findings.
• 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 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.

We saw several areas of outstanding practice including:

• The practice hosted Harrogate Borough Council Health and Wellbeing team at the practice where they ran ‘Fit 4 Function’ classes. This was a fun class aimed at helping patients to improve their posture, strength, agility, coordination, balance and general health. GPs or other health professionals could refer patients to these classes or the patient could arrange attendance themselves. Feedback from external stakeholders was extremely positive about how the model the practice had implemented had helped to deliver the success of the Active Health Referral Scheme. Feedback we saw showed the Health and Wellbeing team was promoting the model adopted by the practice with other GP surgeries as best practice and within a wider arena.

• We were provided with a considerable amount of positive feedback in respect of the care provided to patients receiving end of life care and the care and support received by bereaved families. GPs that lived locally provided families with their personal telephone numbers so that they could be contacted out of hours. Feedback from external stakeholders was extremely positive.

• The practice had a system in place whereby one GP was available as a ‘floating’ GP each day which allowed for home visits to be made at any time assessed as needed. For example following up a patient of concern that had been seen the day before with an early morning visit.

There was an area of practice where the provider must make improvement:

• Ensure sufficient arrangements are in place to ensure medicines are always safely managed.

There were areas of practice where the provider should make improvements:

• Review the arrangements currently in place for revisiting changes introduced by the practice over time to ensure they are effective and embedded within the practice.

• Review the governance arrangements currently in place for monitoring training to ensure the system is effective and affords the management oversight of what training is due to be completed and updated.

• Review the effectiveness of the governance arrangements in place for the recruitment of staff to ensure staff are recruited in a safe and timely way.

• Review the arrangements for supervising dispensing staff to ensure dispensing staff are supervised by a member of staff with detailed knowledge of their role

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with patients, in private, who visited the surgery on the day of our inspection. We spoke with a GP, the practice manager and other team members too.

Patients told us they were very happy with the care and support they received from this practice. Some people said they were happy to see any doctor or nurse as "The surgery provides a good service and it is very easy to get seen by a doctor or nurse here.” Another told us "The Doctors listen. I never feel rushed.” This meant patients felt their views about their care and treatment were listened to and their needs were met.

We found patients were protected from the risk of abuse. One patient told us “The Doctors go beyond the call of duty.”

We saw there were systems in place to reduce the risk and spread of infection. Patients told us the surgery was always clean and tidy.

We found patients were cared for by staff who received time and support for appropriate professional development.

Patients told us that they had not had any reason to complain; but if necessary they would speak immediately to either the doctor or the practice manager.