Letter from the Chief Inspector of General Practice

We previously inspected Dr William Porters practice on 2 August 2016. As a result of our inspection visit, the practice was rated as requires improvement. Specifically, the practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led service. A requirement notice was issued to the provider. This was because we identified regulatory breaches in relation to regulation 12, Safe care and treatment, regulation 17, Good governance and regulation 18, Staffing. We identified some areas where the provider must make improvements and some areas where the provider should make improvements.

We carried out an announced comprehensive inspection at Dr William Porters practice, also known as St James’s Medical Practice on 13 June 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Dr William Porter on our website at www.cqc.org.uk.

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

• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. We noted improvements with regards to the management of safety alerts during our most recent inspection and evidence demonstrated that clinicians received and acted on alerts when needed.

• Significant events and audits were used as opportunities to drive improvements. Some audits were completed in response to the findings from our previous inspection, including audits focussing on the effectiveness of failsafe systems for cytology results.

• When we inspected the practice in 2016 we found that some areas of monitoring high risk medicines required improvement. During our most recent inspection we saw that patients prescribed high risk medicines were monitored and reviewed.

• We noted significant improvement to staff files during our most recent inspection. The files showed that appropriate recruitment checks had been undertaken prior to employment, overall we found that the files were organised. A locum induction pack was also implemented following our previous inspection.

• Most recently we saw that more formal supervision was in place for the practice nurse prescriber, with support from the practice GP. The nurse had also attended prescribing updates relevant to the areas they prescribed in.

• We observed the premises and medical equipment to be visibly clean. Previously we found that records were not kept to reflect the cleaning of specific medical equipment. Most recently we saw records to demonstrate that the equipment used for ear irrigation was cleaned, but there were no records in place to support the cleaning of other medical equipment.

• Although the practices cervical screening uptake had improved by 2% since our previous inspection, cervical screening and bowel cancer screening rates remained below local and national averages.

• When we inspected the practice in 2016 we found some patients at risk of hospital admission did not have personalised care plans in place. During our most recent inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

• Since 2016, the practices carers register had increased from 18 to 26 carers; this was 1% of the practices list. Although there was some support in place for carers, there was no information available to take away or on display in the practice to support carers.
• There was information about how to complain on the practice website and the practice displayed this information in the waiting area following our inspection.
• During our most recent inspection we saw improvements in governance, risk management and record keeping across areas including the management of the cold chain (for the safe storage and handling of vaccinations).

The areas where the provider should make improvements are:

• Continue to focus on improving cancer screening rates overall.

• Ensure that carers are able to easily access supportive information and continue to identify carers in order to offer them support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously inspected Dr William Porters practice on 2 August 2016. As a result of our inspection visit, the practice was rated as requires improvement. Specifically, the practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led service. A requirement notice was issued to the provider. This was because we identified regulatory breaches in relation to regulation 12, Safe care and treatment, regulation 17, Good governance and regulation 18, Staffing. We identified some areas where the provider must make improvements and some areas where the provider should make improvements.

We carried out an announced comprehensive inspection at Dr William Porters practice, also known as St James’s Medical Practice on 13 June 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Dr William Porter on our website at www.cqc.org.uk.

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

• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. We noted improvements with regards to the management of safety alerts during our most recent inspection and evidence demonstrated that clinicians received and acted on alerts when needed.

• Significant events and audits were used as opportunities to drive improvements. Some audits were completed in response to the findings from our previous inspection, including audits focussing on the effectiveness of failsafe systems for cytology results.

• When we inspected the practice in 2016 we found that some areas of monitoring high risk medicines required improvement. During our most recent inspection we saw that patients prescribed high risk medicines were monitored and reviewed.

• We noted significant improvement to staff files during our most recent inspection. The files showed that appropriate recruitment checks had been undertaken prior to employment, overall we found that the files were organised. A locum induction pack was also implemented following our previous inspection.

• Most recently we saw that more formal supervision was in place for the practice nurse prescriber, with support from the practice GP. The nurse had also attended prescribing updates relevant to the areas they prescribed in.

• We observed the premises and medical equipment to be visibly clean. Previously we found that records were not kept to reflect the cleaning of specific medical equipment. Most recently we saw records to demonstrate that the equipment used for ear irrigation was cleaned, but there were no records in place to support the cleaning of other medical equipment.

• Although the practices cervical screening uptake had improved by 2% since our previous inspection, cervical screening and bowel cancer screening rates remained below local and national averages.

• When we inspected the practice in 2016 we found some patients at risk of hospital admission did not have personalised care plans in place. During our most recent inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

• Since 2016, the practices carers register had increased from 18 to 26 carers; this was 1% of the practices list. Although there was some support in place for carers, there was no information available to take away or on display in the practice to support carers.
• There was information about how to complain on the practice website and the practice displayed this information in the waiting area following our inspection.
• During our most recent inspection we saw improvements in governance, risk management and record keeping across areas including the management of the cold chain (for the safe storage and handling of vaccinations).

The areas where the provider should make improvements are:

• Continue to focus on improving cancer screening rates overall.

• Ensure that carers are able to easily access supportive information and continue to identify carers in order to offer them support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with five patients and five members of staff. One patient said, “He is a perfect gentleman, he went out of his way to help my wife." The patients we spoke with said they were able to obtain appointments at a time to suit their needs and that they did not have to wait long once they arrived at the practice.

We saw that patient's views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. One patient told us, “I have never had any reason to make a complaint." We saw that patients experienced care and treatment that met their needs. Patients told us and we saw that care was delivered in a clean environment.

There were good systems in place to ensure patient's medication was reviewed regularly. The patients we spoke with said that good explanations of their medication were always given.

There were good systems in place to assess and monitor the quality of service that people received.