Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Street Surgery on 28 February 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 28 February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had improved patients access to information regarding their complaints system. Posters were displayed within the reception area.

• The practice had systems to support patients with limited mobility, including wheelchair users, to access the building and their services.
• The practice had strengthened systems, processes and practices to minimise risks to patient safety.
• Staff had received training on safeguarding children and vulnerable adults relevant to their role.
• The practice had arrangements to respond to emergencies and major incidents.
• Staff had access to appropriate training and had the skills and knowledge to deliver effective care.
• Data from the national GP patient survey, published in July 2017 showed improvements in some aspects of care from July 2016.
• The practice had identified 1.6% of their patient list as carers and provided information and support for them to access services.
• The practice had introduced and were embedding systems to support the delivery of good quality care. This included arrangements to monitor and improve quality and identify risk.
• Staff attended meetings and were supported to undertake training opportunities.

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 the High Street Surgery on 26 August 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2015 inspection can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

After the inspection in August 2015 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

The inspection carried out on 28 February 2017 found that the practice had responded to the concerns raised at the August 2015 inspection and had implemented their action plan in order to comply with the requirement notices issued. However, we found other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the practice remains requires improvement.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system for reporting and recording significant events.

• The practice’s systems, processes and practices did not always keep patients safe. Nor were risks to patients assessed and managed in an effective and timely manner.

• The practice did not always maintain appropriate standards of cleanliness and hygiene.

• The practice did not have adequate arrangements to respond to emergencies at the Whitfield Surgery.

• The arrangements for managing medicines, including emergency medicines and vaccines, in the practice did not always minimise risks to patient safety.

• Staff were aware of current evidence based guidance. The practice could demonstrate how they ensured role-specific training and updating for relevant staff.
• Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. However, the practice was below average for its satisfaction scores on consultations with GPs and nurses.

• There was information in the practice leaflet for new patients directing complainants to the practice manager. However, there were no complaints information posters displayed, information published on their website or a complaints leaflet made available.

• 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.
• The practice had some good facilities. However, some areas of the practice had not been well maintained.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that the practice has regard to The Health and Social Care Act 2008, Code of practice on the prevention and control of infections and related guidance.

• Revise medicines management processes to help ensure there is a system to monitor blank prescription forms and pads and track them through the practice. Ensure that vaccines are stored appropriately. Ensure staff read, understand and sign standard operating procedures relevant to their role and errors and near misses are consistently reported and discussions take place for staff to learn lessons to reduce further risk.

• Ensure appropriate recruitment checks are undertaken prior to the employment of all staff, including directly employed locum GPs. Ensure all staff are up to date with mandatory training.

• Revise risk management and governance documents to ensure that all risks to patients, staff and visitors are identified and managing in an effective and timely manner. For example, fire risk assessments and evacuation, infection prevention and control, legionella management and responding to medical emergencies.

In addition the provider should:

• Review how information is shared with patients who may wish to make a compliant.

• Review how patients who use wheel chairs access the practice.

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 High Street Surgery on 28 February 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 28 February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had improved patients access to information regarding their complaints system. Posters were displayed within the reception area.

• The practice had systems to support patients with limited mobility, including wheelchair users, to access the building and their services.
• The practice had strengthened systems, processes and practices to minimise risks to patient safety.
• Staff had received training on safeguarding children and vulnerable adults relevant to their role.
• The practice had arrangements to respond to emergencies and major incidents.
• Staff had access to appropriate training and had the skills and knowledge to deliver effective care.
• Data from the national GP patient survey, published in July 2017 showed improvements in some aspects of care from July 2016.
• The practice had identified 1.6% of their patient list as carers and provided information and support for them to access services.
• The practice had introduced and were embedding systems to support the delivery of good quality care. This included arrangements to monitor and improve quality and identify risk.
• Staff attended meetings and were supported to undertake training opportunities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients who used the service told us they were satisfied with the care and treatment they received. Patients told us they felt their needs and medical issues were taken seriously and dealt with appropriately. They also told us they were involved in their care and could discuss different options available to them with the doctor.

We found that a touch screen facility for booking in for an appointment was available for patients as well as reporting to reception so that staff knew they were there. Patients told us the staff treated them respectfully and were helpful. We saw that staff spoke politely to patients and consultations were carried out in private treatment rooms.

We found that the provider could not be sure that all staff were suitable to work with vulnerable patients because not all pre-employment checks had been completed. Patients told us they knew how to make a complaint and that any issues would be taken seriously.