Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Black & Partners on 14 June 2016. The overall rating for the practice was good, but it was rated as ‘requires improvement’ for providing safe services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Black & Partners on our website at www.cqc.org.uk.

We carried out an announced focused inspection on 14 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 June 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Improvements had been made to the systems and processes in place which was highlighted following our initial inspection. Specifically the arrangements for delivering safe care and treatment.
• The practice had clearly defined and embedded systems to ensure clinical oversight of medicine management processes to support the safe issue of prescriptions.
• Risks to patients and staff were assessed and well managed. This included fire safety, management of legionella, and health and safety.
• The practice had a comprehensive business continuity plan for major incidents and copies of the plan were held off site.

The areas where the provider should make improvement are:

• Ensure additional member(s) of staff are identified and trained to carry out the weekly testing of fire safety arrangements to support the responsible person in their absence.

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 Dr Black and Partners on 14 June 2016. 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. These were discussed regularly with practice staff.
• Risks to patients were assessed and well managed overall. However, the provider needed to make improvements to some of their medicines management processes.
• The practice had recently lost some key members of their management and clinical team and had used an external consultancy to work with them in identifying recruitment options based on skills required for the practice.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients was consistently positive about the care they received.
• 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 that urgent appointments were always available the same day but that they sometimes need to wait to see their preferred GP for a routine appointment. The practice had implemented a system where patients were seen on the day by an urgent care practitioner who was trained to the level of Advanced Nurse Practitioner (ANP)
• The practice was purpose built, had good facilities and was well equipped to treat patients and meet their needs.
• Staff had strong and visible leadership and said they felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are;

• Enabling the safe and proper management of medicines ensuring there is clinical oversight of all amendments and additions to prescriptions

• Assessing the risk of, and preventing, detecting and controlling the spread of, infections by assessing the risk of legionella and taking necessary action to mitigate this
• Ensuring that the premises used by the service provider are safe to use for their intended purpose and are used in a safe way by ensuring the arrangements for fire safety risk assessment and testing are in place to protect patients from the risk of fire.

The areas where the provider should make improvement are;

• Consider whether the business continuity plan should be available off site.
• Review the documentation relating to risks assessed for staff and patients to ensure these are robust, regularly reviewed and accessible.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with five patients during our inspection, three of whom had attended with children. Patients told us they felt they were treated with dignity and respect by staff. One patient said "Lovely, and everyone is helpful”and an newly registered patient said, “It has been a very good experience so far.”

Patients said they could book appointments in advance or telephone at 8am in the morning for an urgent appointment and they would be added to the triage list. The GP would contact them and book a same day appointment if required. Two of the five patients told us they thought the introduction of the triage system had made it easier to get an urgent appointment. Patients told us they felt involved in their care and were able to ask questions.

Staff had received training in safeguarding children and vulnerable adults and were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

We saw that the provider had robust recruitment and selection procedures in place for newly recruited staff, and had checked the suitability of existing staff to work with patients and access confidential information.

The provider had systems in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.