This practice is rated as Good overall. (Previous inspection 16 December 2015 – Good)

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 living with dementia) - Good

We carried out an announced comprehensive inspection of Nethrgreen Surgery on 7 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear 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.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect and feedback from patients about their care was consistently positive.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Structures, processes and systems to support good governance and management were clearly set out, understood and effective.
• Openness, honesty and transparency were demonstrated when responding to incidents and complaints. The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.
• There was a clear leadership structure and staff stated they felt respected, supported and valued. They felt part of a team and were proud to work in the practice.

We saw one area of outstanding practice:

• The practice had recently implemented a digital asthma review system for patients who had failed to attend their annual review appointment to assess and ensure their asthma was adequately managed.

The areas where the provider should make improvements are:

• Review access to the blank prescription stationery cupboard key.
• Review the timeliness of requesting disclosure and barring service (DBS) checks for new staff as specified in the recruitment policy.
• Review the procedure for recording safeguarding incidents in the patient record.

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 Nethergreen Surgery on 16 December 2015. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Most risks to patients were assessed and well managed, with the exception of those relating to premises.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. However, training records did not identify all the training staff had completed.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an urgent appointment although they could wait two to three weeks for a routine appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs. There was no oxygen available on site to deal with medical emergencies. However, the practice have since provided evidence that this had been obtained.
• 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.
• The registered provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

• The practice offered patients with learning disabilities pictoral information sheets and easy to read appointment letters to improve communication.

• The practice had developed a frailty register to identify patients who were becoming increasingly frail.

The areas where the provider should make improvements are:

• Maintain records of all staff training.

• Ensure oxygen is available on site to deal with medical emergencies.

• Implement a system to ensure all Health and Safety risks relating to premises are identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

All the patients told us that their privacy and dignity was always respected when attending the practice. Patients were very satisfied with the care, support and advice they had received. Patient’s comments included: “I like the attitude of all the doctors”, “it’s brilliant, I’d recommend anyone to come here” and “getting an appointment is fine, they’ll (receptionists) always do their best to get you in whatever you need”

All staff spoken were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse. One staff member commented: “we have the safeguarding training every year and we all know what to do if we’re concerned about a patient”.

Patients spoken with did not have any concerns about the cleanliness of the practice.

When we spoke with staff they told us that they felt supported by the doctors and the practice manager. They told us that they felt they could approach either to raise any concerns they had. One staff member commented: “It’s a really supportive team, we can talk with doctors anytime and the nurses always talk to each other”.

After the inspection we contacted two members of the patient participation group by phone. They told us that the group met regularly at the practice with one of the doctors and the practice manager and that their views were listened to and influenced how the practice moved forward. One member commented: “the doctors take us seriously”.