At our previous inspection on 22 November 2018, the overall rating for the practice was good with requires improvement for providing safe services. The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Dr Joseph Fowler on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 October 2018 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 22 November 2018. This report covers our findings in relation to those requirements and any additional improvements made since our last inspection.

Overall the practice is now rated as good.

At this inspection we found:

• Systems were in place for the safe management of high risk medicines.
• A system to track blank prescription pads and forms used in printers throughout the practice had been introduced.
• The practice had introduced a consistent approach to the documentation of significant events so that the sequence of events, analysis, investigation, follow up and learning was clearly identified.
• The practice had reviewed its approach to identifying carers.
• The results of the July 2018 national GP patient survey showed that patients were very satisfied with the service they received from the practice. The practice had scored higher than the clinical commissioning group (CCG) averages in all questions.
• Reception staff had received varied training to ensure they were aware of ‘red flag’ sepsis symptoms that might be reported by patients and how they should respond.
• Appropriate systems in line with NICE guidance had been implemented for the assessment of patients with presumed sepsis.
• Despite patients’ reluctance, the practice continued to actively encourage patients to form a patient participation group (PPG). The practice ensured that patients were kept up to date through other media which included detailed quarterly newsletters, posters and impromptu conversations in the waiting room.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (The practice was rated good at our previous inspection 15 May 2015)

The key questions are rated as:

Are services safe? – Requires Improvement

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

We carried out an announced comprehensive inspection at Dr Joseph Fowler on 22 November 2017. We carried out this inspection as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a clear leadership structure and staff felt supported by management.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Introduce a consistent approach to the documentation of significant events so that the sequence of events, analysis, investigation, follow up and learning is clearly identified.
• Take a more active approach to identifying carers.
• Ensure that receptionists are aware of ‘red flag’ sepsis symptoms that might be reported by patients and how they should respond.
• Consider developing and implementing a children’s and adult sepsis protocol for all staff to access.
• Review the systems in place for the assessment of patients with presumed sepsis to ensure that they are in line with NICE guidance.
• Continue to actively encourage patients to form a patient participation group PPG.

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. Joseph Fowler practice on 15 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, responsive, caring and well led services. It was also rated as good for providing services for all population groups.

Our key findings were as follows:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• Patients said that they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available and easy to understand.
• Although some clinical audits had been carried out, we saw little documented evidence to suggest these audits were driving improvement in performance to improve patient outcomes.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• There was a clear leadership structure and staff felt supported by management.
• The practice sought feedback from staff and patients, which it acted on.
• Patients had access to a psychologist for counselling and support each Thursday following a GP referral.

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

The provider should:

• Ensure the methods used for review and dissemination of learning from significant events and near misses are robust and maintain consistency in recording the analysis and outcome of significant events.

• Ensure all staff are aware of and can identify with the practice vision and values.
• Formalise and strengthen the informal governance and leadership arrangements in place.
• Consider improving entry access for disabled patients.
• Consider an automated external defibrillator (used to attempt to restart a person’s heart in an emergency for use in the event of an emergency).
• Ensure medicines for low blood sugar and seizure are available in the event of an emergency or complete a risk assessment in respect of why they are not required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice