Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

At our previous inspection in August 2016 the practice had an overall rating as Good.

Following the March 2018 inspection, the key questions are rated as:

• Are services safe? – Good

• Are services effective? – Good

• Are services caring? – Good

• Are services responsive? – Good

• Are services well-led? - Good

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 – Good

• People with long-term conditions – Good

• Families, children and young people – Good

• Working age people (including those recently retired and students – Good

• People whose circumstances may make them vulnerable – Good

• People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Montgomery-House Surgery in Bicester, Oxfordshire on 6 March 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Montgomery-House Surgery was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen and any notable events either positive or negative were learned from.
• The practice had defined and embedded systems, processes and practices to minimise risks to patient safety.
• Staff had received training appropriate to their roles and the population the practice served. Any further training needs had been identified and planned.
• Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
• Patients ongoing care needs were assessed, monitored and managed, including planned reviews of their needs.
• We received positive feedback from patients regarding staff, care and treatment.
• Services were reviewed to make improvements, such as increasing online access to clinical support and appointment booking.
• The practice learned lessons from individual concerns and complaints and also from analysis of trends.
• The practice had clear and visible clinical and managerial leadership and supporting governance arrangements.
• There was an open and supportive culture among the staff group.

There were areas the provider should make improvements:

• Continue to review and embed the amended systems for ensuring all actions regarding medicine reviews and medicine alerts are completed.

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 Montgomery-House Surgery on 20 October 2015. We have rated the practice as good overall, but the practice requires improvement in the effective domain.

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. There was an open culture regarding reporting of incidents and events. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were nearly always assessed and well managed. Some protocols regarding medicines management were not fully robust.
• Staff recruitment, training and support ensured they were safe and able to fulfil their roles.
• 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.

• The practice was clean and well maintained.
• There was monitoring of patient care including a programme of clinical audit. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The exception reporting of patients on the quality outcomes framework tool was much higher than national averages in 2014 and 2015 but this had not been identified as an area for improvement.
• Information about services and how to complain was available.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice was highly responsive to the needs of its patients and when feedback suggested improvements could be made.
• 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.

We saw some outstanding practice for families, children and young people including:

• The practice had a page on a popular social media website, with health promotion posts and information about services to widen information sources for patients. We saw this included information on preventing child illness and information events held at the practice.

• There was a young peoples’ advice zone in front entrance, where advice leaflets relevant to this age group were displayed.

However there were areas of practice where the provider must make improvements:

• Review monitoring of patient care to ensure that patients are included in data which indicates whether appropriate care is received. Exception reporting in the quality outcomes framework reporting indicated monitoring of patient care and treatment was not always taking place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In October 2015, during an announced comprehensive inspection of Montgomery-House Surgery, we found issues relating to the monitoring of patient care and treatment, indicated by a high level of exception reporting in the Quality Outcomes Framework (QOF) data. QOF is a system intended to improve the quality of general practice and reward good practice by monitoring outcomes for patients. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting, or certain medicines cannot be prescribed because of side effects.. This was assessed as being in breach of Health and Social Care Act 2008 Regulations.

Following the inspection the provider sent us an action plan detailing how they would review the monitoring of patient care to ensure that patients were included in data to evidence that appropriate care and treatment was being received.

We carried out a desktop review of Montgomery-House Surgery in July 2016 to ensure these changes had been implemented and that the service was meeting Regulations.

We found the practice had made improvements since our last inspection in October 2015 and that it was meeting the Regulation relating to monitoring patient care that had previously been breached.

Specifically, the practice was found to have undertaken work to address its previously high QOF exception reporting rate in a number of clinical domains, by:

• Undertaking an audit into exception reporting for all QOF clinical domains.

• Undertaking an audit focussed on QOF exception reporting for patients with asthma.

• Undertaking actions identified by these audits, including amending coding practices on patient records and encouraging patients to attend annual reviews for long-term conditions.

Although QOF data for 2015/16 has not yet been validated and published, the practice has submitted its figures for the period which evidence that improvements to exception reporting rates have been made.

The ratings for the practice have been updated to reflect our findings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice