Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of City Way Surgery 23 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patient’s needs were assessed and care was planned and delivered in line with current legislation. Staff had received training appropriate to their roles.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. Staff treated patients with kindness and respect, and maintained confidentiality.
• Patients said they experienced few difficulties when making appointments and urgent appointments were available the same day.
• There was a leadership structure and staff felt supported by management. The practice took into account the views of patients and those close to them as well as engaging with staff when planning and delivering services.

However, there were areas of practice where the provider needs to make improvements.

The provider should;

• Ensure that all documents used to govern activity are up to date and contain relevant contact details.

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 focussed inspection on 29 and 31 October 2014. The inspection was carried out over two days as one of our inspection team became unwell during the inspection visit on 29 October 2014. There was therefore insufficient time for the remaining staff to establish enough information in one day which is why we returned on a second day. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, interviewed staff of all levels and checked that the correct systems and processes were in place.

City Way Surgery has not received a rating as this was a focussed inspection.

Our key findings were as follows:

• City Way Surgery had systems to monitor, maintain and improve safety and demonstrated learning from significant events. The practice had policies to safeguard vulnerable adults and children who used services. There was enough equipment, including equipment for use in an emergency, to enable staff to care for patients. Staff were trained and the practice had plans to deal with foreseeable emergencies. However, the practice did not have a system to adequately monitor on-going safety and had not always responded to identified risks. Patients’ records and blank prescription forms were not always held securely. Insufficient numbers of staff with the skills and experience required to meet patients’ needs were employed. Some records such as significant event records were incomplete.
• Staff at the City Way Surgery followed best practice guidance and had systems to monitor, maintain and improve patient care. There was a process to recruit, support and manage staff. Equipment and facilities were monitored and kept up to date to support staff to deliver effective services to patients. The practice worked with other services to deliver effective care and had a proactive approach to health promotion and prevention.
• Patients were satisfied with the care provided by City Way Surgery and were treated with respect. Staff were careful to keep patients’ confidential information private and maintained patients’ dignity at all times. Patients were supported to make informed choices about the care they wished to receive and most patients said they felt listened to. The practice provided opportunities for patients to manage their own health, care and wellbeing and maximised their independence.
• The practice was responsive to patients’ individual needs such as language requirements, some mobility issues as well as cultural and religious customs and beliefs. However, access to services for all patients was limited.
• Although City Way Surgery had a vision statement to provide high quality care and best practice to its patients, none of the staff we spoke with were aware of it. The practice had dedicated lead GPs for certain issues such as safeguarding. However, there was a lack of clear leadership structure. The practice used a variety of policies and other documents to govern activity and there were regular governance meetings. However, there was not an effective system to help ensure all governance documents were kept up to date. There were systems to monitor as well as improve quality and the practice was able to demonstrate clinical audit activity. The practice did not always take into account the views of patients and those close to them when planning and delivering services. The practice valued learning but did not always share learning outside of the partners’ practice meetings. Systems to identify and reduce risk were not always employed effectively.

The areas where the provider must make improvements are:

• Review its arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs as well as improve access to primary medical services for all patients.
• Review its system to manage and record significant events as well as ensure that patients’ records are held securely at all times.
• Address its leadership issues and review its system of monitoring safety and responding to risk.
• Address its response to patients’ comments and suggestions received through the patient participation group meetings, complaints received, reviews left on the NHS Choices website and patient survey results.
• Improve its policy review system and clinical audit activity to comply with its own governance policies.

In addition the provider should:

• Review its system to manage National Patient Safety Alerts as well as the information available in its whistleblowing policy.
• Ensure that relevant information is shared with all staff members.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice