We carried out this announced comprehensive inspection at Faccini House Surgery on 29 January 2019. We had previously carried out an announced comprehensive inspection on 23 November 2017. At that time the service was rated as requires improvement. It was rated as requires improvement for the safe, effective and well led domains and good for caring and responsive.

The areas where we said that the provider must make improvement were:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care with regards to: clinical governance, risk management and monitoring care and treatment for people with long-term conditions and mental health conditions.
• The areas where we said the provider should make improvements were:
• Review and improve uptake for immunisations and screening programmes.
• Improve patient satisfaction with care and treatment and access to the service.
• Make information about how to make a complaint or raise concerns readily available to patients and the public.
• Review practice policies and procedures so the duty of candour is clearly reflected.
• Improve systems for engaging with patients, obtaining patient feedback and acting on concerns.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

At this inspection we found that the practice had addressed all of the issued from the previous inspection, and have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Consider reviewing the way in which it records adult patients with a safeguarding concern.
• Review the security of clinical waste storage prior to collection.
• Review systems for monitoring the security of blank prescription stationary.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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 requires improvement overall. (The practice was previously inspected on 13 January 2015 and was rated as good overall.)

The key questions are rated as:

Are services safe? – good

Are services effective? – requires improvement

Are services caring? – requires improvement

Are services responsive? – requires improvement

Are services well-led? - requires improvement

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 – requires improvement

People with long-term conditions – requires improvement

Families, children and young people – requires improvement

Working age people (including those retired and students – requires improvement

People whose circumstances may make them vulnerable – requires improvement

People experiencing poor mental health (including people with dementia) - requires improvement

We undertook an announced comprehensive inspection of Faccini House Surgery on 23 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was carried out in line with our next phase inspection programme but also in response to information sharing from the General Medical Council and concerns from monitoring information we review about the practice.

At this inspection we found:

• There was no clear process for acting on safety and medicines alerts.

• The practice did not have adequate assurance that one of the nurse practitioners who had been working alone during Saturday morning clinics had indemnity cover and up to date basic life support training appropriate to their role. The practice resolved these issues following the inspection.

• Care and treatment was not monitored effectively enough for people with long-term conditions and mental health conditions.

• The practice did not hold structured clinical meetings. This limited opportunities for clinical staff to share best practice, discuss clinical risks and provide peer support.

• Staff told us that they treated patients with compassion, kindness, dignity and respect and involved patients in decisions about their care. However national GP patient survey data indicated that patient satisfaction with care shown during consultations was low.

• Although the practice had tried to improve appointment availability, patients found it difficult to contact the practice by telephone and they reported that they were not able to easily see their preferred GP.

• Patients had difficulty getting an appointment on the day.

• Complaints were investigated and responded to openly and thoroughly, however information about how to make a complaint was not easily accessible for patients.

• The practice had recently worked with the Patient Participation Group (PPG) to gather patient views. However systems for engaging with patients and acting on concerns were not well-established.

• The practice had a some well-managed systems in place to keep people safe and reduce risk so that safety incidents were less like to happen.

• There was a positive and open culture and staff felt supported by the practice leaders.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care with regards to: clinical governance, risk management and monitoring care and treatment for people with long-term conditions and mental health conditions.

The areas where the provider should make improvements are:

• Review and improve uptake for immunisations and screening programmes.

• Improve patient satisfaction with care and treatment and access to the service.

• Make information about how to make a complaint or raise concerns readily available to patients and the public.

• Review practice policies and procedures so the duty of candour is clearly reflected.

• Improve systems for engaging with patients, obtaining patient feedback and acting on concerns.

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 Faccini House Surgery on 13 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for all the population groups including older people; people with long term conditions; mothers, babies, children and young people; the working age populations and those recently retired; people in vulnerable circumstances and people experiencing poor mental health.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Risks to patients were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain were available and easy to understand.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice