Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Favell Plus Surgery on 22 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Favell Plus Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulation that we identified in our previous inspection on 22 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

On this focused inspection we found that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing safe and well-led services. As this applies to everyone using the practice, the population group ratings have been updated to reflect this. Overall the practice is now rated as good.

Our key finding was as follows:

• The practice had effective governance arrangements in place to ensure patient safety alerts were managed appropriately and staff took action to keep patients safe.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• A fire drill had been completed and documented.
• There was evidence the practice involved patients and was developing engagement with its Patient Participation Group (PPG). (The PPG is a community of patients who work with the practice to discuss and develop the services provided).
• The practice discussed their below average satisfaction scores from the National GP Patient Surveys published in January and July 2017. They demonstrated they had taken action to respond to these in an attempt to improve future results. We saw their focus had been on improving patients’ overall experience of the practice. This included employing three new reception staff in July 2017, increasing the overall availability of the team by 40 hours each week. An additional telephone line was installed to increase the call handling capacity of the reception team, especially at peak times. The recruitment of a new GP in December 2017 had provided an additional 24 pre-bookable appointments each week and increased the availability of same day appointments. The nursing team rotas had been reviewed and altered to increase the availability of late afternoon appointments to better meet the needs of working age patients. One of the practice nurses was now working an additional seven hours each week to assist with this.
• Following our inspection in June 2017 a practice nurse had been appointed as the practice’s carers’ lead (or champion) responsible for providing useful and relevant information to those patients. The relevant staff we spoke with told us their priority since our last inspection had been to ensure the practice’s carers register (those patients on the practice list identified as carers) was correct and accurately reflected those patients who were active in a carer role. We saw a piece of work had been completed to achieve that. Staff told us the focus moving forward was to identify more carers in the practice’s patient population. At the time of this focused inspection on 22 March 2018 the practice had identified 61 patients on the practice list as carers. This was approximately 0.7% of the practice’s patient list. Of those, 40 (66%) had been invited for and 24 had accepted and received a health review since 1 April 2017. Twelve of those patients were referred to Northamptonshire Carers (a local support organisation). A dedicated carers’ notice board was prominently displayed in the patient waiting area and provided considerable information and advice including signposting carers to support services. A notice in the practice and on their website invited patients who identified as carers to make themselves known to the practice to ensure they received the appropriate support.
• We found the practice now had an effective system in place for handling verbal complaints. We looked at the details of four verbal complaints received between September 2017 and January 2018 and saw that as with written complaints, they were recorded, investigated and dealt with in a timely way with openness and transparency. Where appropriate, action was taken as a result to improve the quality of care or patient experience. All of the staff we spoke with understood the process to follow if a patient wished to raise a verbal complaint.
• All of the nursing staff had received an appraisal completed by one of the GP partners since September 2017. We saw that training needs assessments formed part of the appraisals. The nurses we spoke with said they were encouraged and given opportunities to develop and the practice provided the appropriate training to meet their needs. For example, both of the practice nurses had passed their initial assessments to complete an independent nurse prescriber course funded by the practice which they were due to attend in September 2018 and March 2019 respectively. Protected learning time would be available for them to do this. They told us the GP partners or nurse practitioner (depending on their role) were proactive in providing them with ongoing support and supervision during clinical sessions.

There was an area of practice where the provider needs to continue to make improvements.

Importantly, the provider should:

• Continue to identify and support carers in its patient population.

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 Abbas & Takla's practice on 27 January 2016. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report significant events and near misses. However, reviews and investigations were often informal and evidence of sharing learning or change of practice was not clear.
• Some risks to patients were assessed and managed, with the exception of those relating to recruitment checks, the cold chain and monitoring of patients taking specific medicines who required close monitoring.
• Urgent appointments were available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, but as these had recently been implemented it was unclear if all staff had been made aware of them.
• The practice had sought feedback from patients and had a patient participation group which they had engaged with but they had become inactive over the last nine months.

The areas where the provider must make improvements are:

• Ensure that patients who require specific monitoring in relation to their medicines are appropriately and safely managed.

• Develop and implement a system that alerts staff to all vulnerable children and adults on the patients care records.

• Develop and implement a system to confirm that actions have been taken following dissemination of safety alerts.

• Ensure recruitment procedures are followed and accurately recorded to include all necessary employment checks for all staff together with a record of this, including medical indemnity arrangements for locum staff and valid Nursing and Midwifery Council (NMC) registration for Practice Nurses.

• Ensure a formal assessment of infection control takes place to assure the practice that infection control procedures are adequate.

• Ensure steps are taken to address the lower than average response to the national patient survey.

In addition, the areas where the provider should make improvements are to:

• Ensure safeguarding, information governance and health and safety training is completed for all staff.

• Ensure more comprehensive information about the practice and procedures is available for locum staff.

• Continue to encourage the PPG to establish regular meetings and formal system of feedback.

• Continue with work on complaints to ensure that learning is shared with all staff.

• Ensure that all staff are aware of the cold chain policy.

• Consider review of the contents of medicines carried in the GP’s bag.

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 Favell Plus Surgery (previously known as Dr Abbas & Takla) on 27 January 2016. Overall the rating for the practice was requires improvement; specifically it was requires improvement for safe, effective, caring, responsive and well-led.

This inspection was an announced comprehensive inspection on 22 June 2017; overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice had clearly embedded systems and processes which promoted learning from events and clear communication with all staff members.
• The practice had systems and processes in place to minimise risks to patient safety in most areas. However, there was no system in place to demonstrate what action had been taken to manage safety alerts.
• The practice had an effective system in place to ensure patients received the required checks before being prescribed certain medicines.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patient comments highlighted that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff felt supported by management and the practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was not active.
• Not all governance structures, systems and processes were effective and enabled the provider to identify, assess and mitigate risks to patients, staff and others.
• The provider was aware of the requirements of the duty of candour. The examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure systems and processes are in place for the effective management of patient safety alerts.

The areas where the provider should make improvements are:

• Ensure fire drills are carried out on a regular basis.
• Implement a system to ensure nursing staff receive formalised supervision and clinical input at annual appraisal.
• Increase membership to the patient participation group and engage with and seek feedback from patients and members.
• Ensure steps are taken to improve areas that are below average in the national GP patient survey results.
• Continue to identify and support Carers.
• Record and analyse verbal complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice