This practice is rated as Good overall. (Previous rating July 2017 – Good overall with caring rated as requires improvement and requires improvement in effective for patients with long term conditions.

The key questions at this inspection are rated as:

Are services effective for patients with long term conditions? – Good

Are services caring? – Good

We carried out an announced focused inspection at Dr Joseph L Practice on 10 August 2018. This inspection was to follow up on breaches of regulation 17 found during our July 2017 inspection which we carried out as a desk based inspection. We reviewed the practice for providing effective services for patients with long term conditions and for providing caring services.

At this inspection we found:

• The percentage of carers had remained the same since the previous inspection. The practice had identified 18 patients as carers resulting in 0.8% of their practice list.
• Patient we spoke with on the day of the inspection were positive regarding the care and treatment they received from staff at the practice.
• National GP patient survey data published in July 2018 portrayed some positive variation in patient satisfaction compared with the July 2017 data.
• The practice had monitored their patient satisfaction throughout the year via internal surveys and found that patients were satisfied with the care and treatment. They had acted on any negative feedback they had received.
• Unverified QOF data for 2017/2018 showed the practice had improved on their clinical outcomes for patients with long term conditions.

The areas where the provider should make improvements are:

• Strengthen the process for the identification of carers.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Joseph L Practice on 20 September 2016 where the practice was rated as good overall. However the practice was found to be requires improvement for providing caring services and for the population group people with long term conditions. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Joseph L Practice on our website at www.cqc.org.uk.

This announced desk based review was carried on 20 July 2017 to confirm that the practice had made the improvements required that were identified in our previous inspection on 20 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice remains rated as requires improvement for providing caring services.

Our key findings were as follows:

• The practice had improved the performance in some of the areas for patients with long term conditions.

• The practice could not show any improvement for the identification of carers.

• The practice had not responded to patient feedback. They had planned to conduct a survey in the practice. However, this had not taken place at the time of the review.

• The patient survey for 2017 showed some improvement. However there will still areas were the satisfaction was below local and national averages.

• The practice had introduced a system to monitor the use of prescription stationery.

• Patient Group Directives (PGDs) were available on the premises and signed accordingly.

• Infection control audits were clearly dated and that the action plan reflected action taken.

Therefore the provider must

Ensure there are systems or processes in place that to seek and act on feedback from relevant persons and other persons on the services provided in the carrying on of the regulated activity, for the purposes of continually evaluating and improving such services.

• Review process and methods for identification of carers and the system for recording this to enable support and advice to be offered to those that require it.

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 L Practice on 20 September 2016. Overall the practice is rated as good.

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

• Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
• The practice assessed most risks to patients and staff. There were systems in place to manage most of these risks. Improvements needed to be made the monitoring of the issue of prescription printer paper and patient group directives needed to be kept onsite (Patient Group Directives or PGDs are a direction to a nurse to administer prescription only medicines such as the flu vaccine).
• The practice responded appropriately to patient and medicine safety alerts when they received them however they were not necessarily getting the latest alerts.
• Although electric sockets had been inspected regularly, there was no system for checking small electrical appliances. However this was rectified a few days after our inspection and evidence provided of this. An ongoing contract for this testing was put in place.
• Staff received appropriate training to provide them with the necessary skills, knowledge and experience to fulfil their role. They had access to further role specific training if appropriate.
• There were some areas where infection control and prevention could be improved. For example, the infection control audit had not been dated and had no action plan attached.
• The practice used national available guidelines to ensure best patient care, however the systems for ensuring they had access to the most current guidance could be improved.
• Patients we spoke with and responses on our comments cards told us that the majority of patients were satisfied with the service received by the practice.
• Information about how to complain was available for patients. Complaints investigations and documentation showed that these were investigated fully.
• Patients told us that they had easy access to appointments. Patients said if all appointments for that day were booked and a cancellation came up then they would be slotted in from those who had been unable to obtain a same day appointment.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from the patient participation forum.
• The practice facilities met the needs of its patient population.
• There was a clear management structure and staff told us they felt supported and able to make suggestions to improve the quality of service provision.
• The previous practice manager had been responsible for the maintenance of the practice website but the practice had not been able to access it since they left, therefore information was incorrect.
• The culture of the practice was open and honest, and the practice complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Introduce a system to monitor the use of prescription stationery.
• Patient Group Directives (PGDs) should be available on the premises.
• Infection control audits should be clearly dated and that the action plan needs to be kept with the audit and updated to reflect action taken, if any required.
• Improve the identification of carers.
• Review the care and treatment provided for patients with long term conditions and improve the performance for patients in this group.
• Respond to patient feedback from the National GP Survey in relation to the satisfaction rates about clinical staff at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice