This practice is rated as Good overall. (Previous rating in April 2018 – Good)

The key questions at this inspection are rated as:

• Are services safe? – Good

When we visited Patford House Surgery Partnership on 4 April 2018, to carry out a comprehensive inspection, we found the practice was not meeting the requirements of the regulation relating to safe care and treatment. The practice was not doing all that was reasonably practicable to mitigate risks. Specifically, we found:

• The practice system for dealing with alerts did not include a feedback system to the management team so they could confirm that all appropriate action had been taken.
• Not all blank prescription forms were being adequately tracked.

We also said the practice should:

• Review what training they define as being essential for staff and their system for recording the training completed by staff.
• Review the recently introduced system for ensuring that all staff are informed of learning from complaints and significant events, to ensure the new system is effective and embedded.
• Review the practice systems for carrying out the routine Legionella checks recommended in their Legionella risk assessment.
• Review the practice exception reporting rates for the prevention of cardiovascular disease within their quality outcomes framework and take appropriate action to reduce this rate.

Overall the practice was rated as Good. They were rated as outstanding for providing caring services, good for providing effective, responsive and well-led services, and requires improvement for providing safe services. The full report of the April 2018, inspection can be found by selecting the ‘all reports’ link for Patford House Surgery Partnership on our website at www.cqc.org.uk.

This report covers the announced follow up focused inspection we carried out at Patford House Surgery Partnership on 01 November 2018, to review the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements.

At this inspection we found the practice had addressed the regulatory breaches we identified on our last inspection. Specifically:

• The medicines alert system included a feedback process to the management team so they could confirm that all appropriate action had been taken.
• Blank prescription forms were now being adequately tracked.

The practice had also made improvements in all the areas we suggested they should address in our previous inspection. For example:

• The practice had reviewed their system for ensuring staff were clear about what training the practice considered essential and for recording the training undertaken by staff. We saw they had introduced an new IT system which helped them keep track of what training was due. This system showed that, apart from a few exceptions due to holidays and newly started staff, all training considered as essential by the practice had been completed.
• The practice had conducted an audit of the system they had introduced shortly before our previous inspection in April 2018, for ensuring that all staff are informed of learning from complaints and significant events. We reviewed the evidence in this audit and found it should the new system appeared to be working effectively.
• The practice had reviewed their exception reporting rates for the two-year period from April 2016 to March 2018, which were above the national average. (Exception reporting is the removal of patients from performance calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.) They had investigated the reasons for this and found that some staff were incorrectly coding items in the IT system. Staff were given refresher training to ensure they knew how to enter data correctly. The practice recognised they had not done enough to monitor their exception rates and had introduced a new policy to monitor this data at regular intervals.

Patford House Surgery Partnership is now rated as good overall and in all key questions, except caring which is rated as outstanding.

• Are services safe? – Good
• Are services effective? – Good
• Are services caring? – Outstanding
• Are services responsive? – Good
• Are services well-led? - Good

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as Good overall.

The key questions are rated as:

• Are services safe? – Requires improvement

• Are services effective? – Good

• Are services caring? – Outstanding

• 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 Patford House Surgery Partnership on 4 April 2018 as part of our inspection programme. We previously inspected the practice in April 2016 when they were rated as good overall and for all the five key questions. The full comprehensive report of our previous inspection can be found by selecting the ‘all reports’ link for Patford House Surgery Partnership on our website at www.cqc.org.uk.

This report covers the finding of our inspection on 4 April 2018. 

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen, except in relation to Safety alerts and Legionella (a term for a particular bacterium which can contaminate water systems in buildings). When incidents did happen, the practice learned from them and improved their processes.

• Systems were in place to deal with safety alerts, medicines alerts or recalls. Alerts were sent to all appropriate staff and the examples we looked at had been appropriately actioned. However, staff were not required to feedback on the action they had taken to the management team so the practice could confirm that all appropriate action had been taken.

• The practice routinely 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.

• Patients’ feedback was consistently positive.  In many areas the practice feedback scores were significantly above the national average.  

• There was a focus on continuous learning and improvement at all levels of the organisation. However, we found some weaknesses in their systems for checking that all learning points had been shared with all appropriate staff and that all actions required in response to safety alerts had been completed.

• The practice had a branch surgery in Sutton Benger which was able to dispense medicines to patients who live more than one mile (1.6km) from their nearest pharmacy premises.

• The practice was a demonstrator site for integrated care in the community.  As part of this they worked in partnership with the other two local practices and other local services to improve community services.  Examples of this work were; a multi-agency meeting to discuss the promotion of healthy alternatives to loneliness in the locality, and regular meetings to discuss the care given to patients in care homes that were attended by representatives of the local community care team, care homes and GP practices, as well as a consultant geriatrician.

We saw one example of outstanding practice.

• The practice worked proactively to support carers. This work was led by a nurse who offered dedicated carer’s telephone appointments on Fridays to address any particularly issues before the weekend. They held carers clinics every three months at the surgery and had held other events for carers in partnership with two other local practices, including a Christmas Party. The practice had identified 224 patients as carers (2.5% of the practice list).

The areas where the provider MUST make improvements are:

• The practice must do all that is reasonably practical to mitigate risks. 

The areas where the provider SHOULD make improvements are:

• Review what training they define as being essential for staff and their system for recording the training completed by staff.

• Review the recently introduced system for ensuring that all staff are informed of learning from complaints and significant events, to ensure the new system is effective and embedded.

• Review the practice systems for carrying out the routine Legionella checks recommended in their Legionella risk assessment.

• Review the practice exception reporting rates for the prevention of cardiovascular disease within their quality outcomes framework and take appropriate action to reduce this rate.​

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 Patford House Surgery Partnership on 14 April 2016. 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.
• Risks to patients were assessed and well managed.

• 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.
• 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 appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

The areas where the provider should make improvement are:

• The provider should review its vaccination programme, to help patients realise the benefits of childhood immunisation.
• The provider should review its access arrangements, so that patients have a greater likelihood of seeing the GP of their choice.
• The provider should seek support to recruit members to its patient participation group, to better reflect the patient population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We saw the practice had established a Patient Participation Group (PPG) to encourage patients to share their views and highlight areas for improvement. We met with one of the participants during our visit and spoke to two others over the telephone. They were able to confirm the PPG had produced a report which included an action plan showing how improvements were going to be made. For example, how the surgery was going to change the phone system to improve access to the appointments system. This meant patients had their views and experiences taken into account in the way the service was provided and delivered.

We were told the surgery had a network of other providers where people were regularly referred for specialist advice such as mental health services. The GP we spoke with described how all of the doctors in the practice had developed areas of professional interest such as asthma or women’s health. This enabled them to provide a higher level of advice to patients before the need to refer anyone onto specialists in these areas. Two of the patients we spoke with had experienced this advice and thought it was a positive benefit.

There was an identified lead GP with a clear role to oversee both safeguarding adults and children within the surgery. This role included reviewing the procedures used in the practice and ensuring staff were up to date and well informed about protecting patients from potential abuse. We saw evidence of the advanced training the GP had undertaken last year to underpin this role.

Records showed there was a comprehensive induction programme which new staff members completed. This included identifying specific raining required by the individual. One member of staff we spoke with who was recruited this year, told us their induction had covered everything they needed to know about their role. This meant the provider had equipped staff with the skills and experience to meet patient's needs.

The surgery completed an annual complaints report in order to analyse and identify trends in the occurrence of complaints and to review learning. We were shown the record of last year’s report by the practice manager and this clearly listed the actions taken and timescales against the complaints.