Letter from the Chief Inspector of General Practice

Pudding Pie Lane Surgery in situated in a rural area of North Somerset with approximately 9000 registered patients. Before visiting, we reviewed a range of information we held about the practice and asked other organisations to share what they knew. This included the North Somerset Clinical Commissioning Group (CCG), NHS England and Healthwatch.

We undertook a comprehensive announced inspection on 3 February 2015. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector and GP specialist advisor. Overall the practice is rated as good.

Specifically, we found the practice to be outstanding for providing responsive services and good for providing well-led, safe, effective and caring services. It was also good for providing services for all of the population groups.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• 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.
• 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 that there was continuity of care, with appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice including:

• Pudding Pie Lane Surgery has staff who were registered as "dementia friends" and support staff to undertake training to be dementia champions.
• The practice has a number of voluntary drivers who can assist patients to attend the practice for treatment. The GPs provide free medical assessments needed by the volunteers for insurance purposes for their role.
• The dispensary based within the service delivers medicines to collection points around the local area, such as the local luncheon club.
• The practice hosts a "Leg Ulcer Club" and treats local patients alongside the community nurses; patients attending the service are invited to stay for tea and cake. This service was set up to treat patients and combat social isolation amongst older patients who may be housebound. The service has volunteer transport for patients who need it.
• The practice has identified "expert patients" with diabetes to participate in a buddying scheme with other diagnosed diabetic patients to support self-management of their illness.

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

In addition the provider should:

• Have arrangements in place so that there is managerial oversight of all the areas of the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous published rating October 2017 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Mendip Vale Medical Practice on 26, 27 and 28 June 2018. This inspection was to follow up the concerns we found at the previous inspection in August 2017. These areas of concern were relating to ensuring that appropriate disclosure and barring checks and training was in place for staff providing chaperone duties and there was proper and safe management of medicines including controlled medicines and prescription paper and pads. Also, the provider must have ensured that staff worked in accordance to the organisations policies and procedures in relation to significant event analysis, emergency medicines, complaints, medicines management and health and safety. In addition, the provider should have continued with the changes they were implementing for infection prevention, the immunisation status of staff, Control of Substances Hazardous to Health(COSHH), fire drills and checks on emergency equipment were sustained. Also, non-clinical staff responsible for telephone handling have the necessary training and guidance for the triage of patient's needs regarding the urgency of being seen by a clinician. The provider should have continued to notify the commission without delay any incidents of serious injury to a service user or events that may stop the service.

These concerns resulted in the practice being rated Requires Improvement overall, with the domains of Safe as Requires Improvement, Effective, Caring and Responsive as Good and Well Led as Inadequate.

At this inspection we found:

That the practice had responded and implemented a programme of improvement and the concerns previously found had been rectified.

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 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 found the appointment system easier to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• The provider should develop its systems of checks and recording information regarding staff vaccinations in accordance to Public Health England (PHE) guidance.
• The practice should strengthen their risk assessment processes for infection prevention and control regarding identified risks and the actions taken to mitigate risks.
• The practice should review the safety and security of the external storage of their clinical waste.
• The practice should review information available to patients regarding chaperone service and processes for offering a chaperone.
• The practice should continue with monitoring and respond accordingly to patient feedback in regard to the concerns about the difficulty in making an appointment and access to appointments.
• The practice should improve how it keeps patients informed about any delays in waiting for appointments.

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.