We carried out an announced comprehensive inspection at Greenfield Surgery on 6 December 2018 as part of our inspection programme.

At the last inspection in January 2018 we rated the practice as requires improvement for providing safe and well-led services because:

• Diagnoses were not always clearly recorded in the patient records.
• Prescription stationary was not monitored appropriately.
• Actions identified by infection control risk assessments were not always clearly recorded or completed.
• Disease registers were not always accurate or up to date.
• Patients who were approaching end of life were not clearly identified.
• Concerns regarding poor performance were not addressed in a timely manner.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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.

We 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.
• Patients could access video consultations with an NHS GP through a smartphone app.

Whilst we found no breaches of regulations, the provider

should

:

• Take action to ensure that the system for monitoring prescriptions within the practice becomes embedded.

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 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? - 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 recently 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 carried out an announced comprehensive inspection at Greenfield Surgery on 22 January 2018. This inspection was carried out as part of our inspection programme. The provider of the service changed in November 2016 and this was the first inspection of the service since the new provider has been providing the service.

At this inspection we found:

• The new provider has made a number of changes to the delivery of the service. However it is too early to tell the impact of many of these changes.
• Staff and patients were positive about the changes that had been made in the service.
• The practice had 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. However, the recording of mitigating actions and shared learning identified by these systems was not always sufficient to support improvement.
• The practice did not always assure itself that systems and processes were operating effectively.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

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

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

• Review how learning is documented and shared with appropriate staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice