Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Meadows Surgery on 2 August 2016. Overall the practice is rated as requires improvement. The full comprehensive report on the 2 August 2016 inspection can be found by selecting the ‘all reports’ link for Meadows Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 July 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 2 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective and well led services. Overall the practice is now rated as good. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

• The practice had reviewed all their documents, policies and processes used to govern activity to ensure they were practice specific and up to date.

• The practice had reviewed and improved the arrangements they had in place for the management of infection control and for the assessment, monitoring and minimising of associated risks. This included the monitoring of actions from infection control audits and ensuring they were addressed, and that all cleaning of clinical equipment was recorded.

• The practice had reviewed it’s systems for the monitoring of staff training and had ensured all staff had received appropriate training to their role including infection prevention control and information governance.

• Clinical staff were involved in the assessment, monitoring and improvement of the quality and safety of the services being provided.

• The outcome of patient’s mental capacity to consent to care or treatment was clearly recorded when this had been assessed by a GP or nurse.

  The practice had made improvements to the recording of complaints to enhance efficiency and the management of the process.

• The practice had improved the way they identified the patients who were also carers which had led to an increase in the number of patients registered as carers on the practice’s list. At the previous inspection, the practice had identified 84 (less than 1% of the practice list) patients as carers. At this inspection we found that the number of patients identified as carers had increased to 145 (approximately 1.5% of the practice’s list).

• The practice had arrangements to provide regular communication and updates to all staff and this had been reviewed to ensure it benefited part time staff.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

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 Meadows Surgery on 2 August 2016. Overall the practice is rated as requires improvement.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Most staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, we found gaps in training for the Mental Capacity Act 2005, infection control and information governance training.
• There was an open and transparent approach to safety and an effective system in place for reporting significant events.
• Most risks to patients were assessed and well managed. However, some systems and processes to address risks were not implemented well enough to ensure patients and staff were kept safe. This included the arrangements to manage infection control and the recording of mental capacity assessments.
• 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.
• Patients said they found it easy to make an appointment, with urgent appointments available the same day. The 26 patient comment cards we received on the day of the inspection all stated they were happy with the care and treatment they received.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice held regular governance meetings and had a number of policies and procedures to govern activity, although not all were practice specific or up to date.
• There was a clear leadership structure and staff felt supported. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice proactively sought feedback from staff and patients, which it acted on. They had made improvements to appointment length and availability in response to patient surveys.
• The practice had an active virtual patient participation group.

The areas where the provider must make improvements are:

• Ensure that all documents and processes used to govern activity are practice specific and up to date. This includes continuing the improvement of documentation and guidance to ensure consistent and timely care planning takes place.
• Ensure there are arrangements in place for the management of infection control and for the assessment, monitoring and minimising of associated risks. This includes that actions from infection control audits are monitored and addressed, and that all cleaning of clinical equipment is recorded.
• Ensure all staff receive training appropriate to their role and continue to improve records and oversight of training, infection control and information governance.
• Ensure all clinical staff are involved in the assessment, monitoring and improvement of the quality and safety of the services being provided by developing an inclusive on-going audit programme in a range of clinical areas.
• Ensure that the outcome is clearly recorded where a patient’s mental capacity to consent to care or treatment has been assessed by a GP or nurse.

In addition the provider should:

• Continue improvements to the recording of complaints to enhance efficiency and the management of the process.
• Continue to monitor and improve processes for recording, acting on and monitoring significant events and ensure that lessons learnt are communicated to the appropriate staff to support improvement at all levels.
• Ensure patients who are carers and who are cared for are pro-actively identified and supported.
• Ensure there are arrangements to provide regular communication and updates to all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice