Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Concept House Surgery on 20 June 2017. Overall the practice is rated as requires improvement.

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

• The systems and processes in place to minimise and mitigate safety risks required improvement.
• The practice facilities and equipment needed maintaining and improving and a program of maintenance implemented in order to maintain a suitable standard.
• The practice arrangements to respond to medical emergencies and major incidents needed improvement.
• Governance arrangements, including management of policies and procedures, risk assessment and management, audits and training required improvement.
• Staff were aware of current evidence based guidance and used them to treat and care for patients.
• The practice recognised its patient population needs and tailored services accordingly.
• Patients said they were treated with care, compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and feedback.
• Appointments were accessible, with extended hours opening on Tuesday evening.
• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.
• The provider was aware of the requirements of the duty of candour.
• There was a clear leadership structure and staff felt supported by management. The practice sought patient views and feedback about improvements that could be made to the service; however the patient participation group (PPG) needed development in order to fully engage a patient’s perspective.

The areas where the provider must make improvement are:

• Ensure that care and treatment is provided in a safe way to patients.
• Ensure all premises and equipment used by the service provider is fit for purpose
• Maintain appropriate standards of hygiene for premises and equipment
• Operate effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvement are:

• Review incidents and significant events that affect the health, safety and welfare of people to identify themes and trends in order to learn from them and prevent further occurrences.

• Review systems for the dissemination, learning and follow up of action to be taken following significant events and incidents.

• Review the training plan to include appropriate intervals for update training in core topics such as basic life support, infection control, mental capacity and safeguarding and ensure these are kept up to date.

• Review the system for documenting action to be taken in response to patient safety alerts.

• Review the system for managing and monitoring the use of evidence based guidance such as National Institute for Health and Care Excellence (NICE) guidelines.

• Review the systems for the safety and monitoring of prescriptions both inside the practice and when carried externally by GPs.

• Review the storage of paper records to ensure they are stored safely.

• Review the website and practice information leaflet to include details of who to contact in the case of the surgery being closed or outside of normal working hours.

• Review the location of the business continuity plan to ensure it is accessible in the case of need.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 20 June 2017 – Requires improvement).

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? - Good

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

At our previous inspection on 20 June 2017 we rated the service as ‘requires improvement’ for two of the five key questions we inspect against. The service required improvement for providing safe and well-led services. The service was therefore rated as ‘requires improvement’ overall. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Concept House Surgery on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Concept House Surgery on 27 March 2018 to check that the provider had made improvements to the service. We found that action had been taken to improve the service and address previous shortfalls.

Our findings were:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• Significant events had been investigated and action had been taken as a result of the learning from events.

• Systems were in place to deal with medical emergencies and staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were carried out appropriately and there were regular checks on the environment and on equipment used.

• Clinicians assessed patients’ needs and delivered care in line with current evidence based guidance. The provider routinely reviewed the effectiveness and appropriateness of the care provided.

• Feedback from patients about the care and treatment they received from clinicians was positive.

• Patients told us they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• Data showed that outcomes for patients at this practice were similar to outcomes for patients locally and nationally.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients told us they found it easy to make an appointment and there was good continuity of care.

• The practice had appropriate facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• Complaints had been investigated and responded to in a timely manner.

• There was a clear leadership and staff structure and staff understood their roles and responsibilities.

• The provider had a clear vision to provide a safe, good quality service.

• Feedback from patients was used to make improvements to the service.

• There was a focus on continuous learning and improvement.

Areas where the provider should make improvements are:

• Review the arrangements for encouraging uptake of childhood immunisations in the patient population.

• Continue to encouragethe uptake of national screening programmes for the patient population.

• Ensure that accurate and appropriately detailed information about how to complain is made readily accessible to patients.

• Introduce a more effective system for monitoring cleanliness.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice