Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (The previous inspection in April 2017 rated the practice as requires improvement.)

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 the 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 had previously inspected this practice on 18 April 2017. At that time we found the practice to be rated as requires improvement for providing safe, effective, caring, responsive and well-led care. The issues identified as requiring improvement affected all the population groups.

We subsequently carried out this announced comprehensive inspection at Shakespeare Medical Practice on 20 December 2017. This was to check whether the practice had addressed and actioned the areas of concern which were raised at the 18 April 2017 inspection.

At this inspection we found:

• All policies and procedures were embedded and easily accessible. Updates were cascaded to staff and discussed in meetings.
• There were systems and processes in place to manage risk.
• There was a named safeguarding lead, who had undertaken the appropriate training.
• There was an embedded system in place for actioning and cascading alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• The processes for reporting and recording significant events had been reviewed and were now embedded. The complaints process had been reviewed to ensure that verbal complaints were captured and acted upon.
• There was evidence of shared learning and actions being taken as a result of reported incidents, complaints and patient feedback. These were used to drive change in service delivery as appropriate. For example, the implementation of additional clinical sessions.
• There was a commitment towards continuous learning and improvement. Learning was shared across all of the provider’s services.
• There was a GP practice ‘screening champion’ who promoted cancer screening and supported patients to access this service. 
• The GP practice had raised awareness of identifying carers and had increased the numbers now on the carers’ register. All these carers had been invited to attend the practice for a review and provided with information as to what additional support mechanisms were available, such as local carers’ groups.
• There was evidence of strong local leadership and management across both the GP practice and walk-in centre. Staff were also supported by the organisational management and leadership team.
• There was a cohesive team approach across both services and staff were positive when talking about the changes that had happened in the GP practice and walk-in centre.

There was an area of outstanding practice:

• The GP practice and walk-in centre staff proactively engaged and supported their patients in a variety of ways. For example, having a children’s’ party to encourage immunisation uptake; a coffee morning for older people; meditation sessions for patients with acute anxiety; a Christmas Day drop-in for lonely patients

There was one area where the provider should make improvements:

• Continue to review and take steps to improve patient satisfaction, relating to the GP practice, in those areas which are below the local and national averages. Such as patients’ satisfaction with feeling listened to, being involved in decisions about their care and their experiences regarding accessing appointments.

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 Shakespeare Medical Practice on 18 April 2017. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events. We saw that significant events were not recorded in a timely way in all cases.
• There were a number of risk assessments in place completed by the landlord of the premises. In addition, the practice had developed a risk register to identify and track known risks affecting the practice and walk in centre.
• Staff had access to current evidence based guidance on the internal intranet. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• We saw that Medicines and Healthcare Products Regulatory Agency (MHRA) alerts were not always acted upon in a timely way. Following our inspection the practice provided evidence to demonstrate that they had improved their processes in relation to this.
• Results from the national GP patient survey (published July 2016), were lower than average in some respects. These results were collected before the current provider took over the contract.
• Information about services and how to complain was available. At the time of our visit we saw that the process for patients to make verbal complaints was unclear. Following our inspection the practice provided evidence that this had been improved. We saw examples of where the practice had responded to complaints in order to improve the quality of service provided to patients.
• Patients we spoke with said they were able to access appointments with a GP in most cases. Urgent appointments were available on the same day. In addition patients were able to access appointments with an Advanced Nurse Practitioner via the Walk in Centre service on site.
• The practice had acknowledged the needs of their patient group and had appointed patient advisors to provide additional social and emotional health support.
• The practice facilities were cramped and space was limited. However we saw that the practice was making good use of the space available. We saw that there were several outstanding maintenance issues in the premises. The practice provided evidence that they were proactively addressing these with the landlord of the premises.
• The senior leadership team at One Medical Group were accessible to staff. Leadership was provided on site by a practice manager and salaried GP. Staff told us management was accessible and supportive.
• The practice had recently established a patient participation group. They described further plans for increasing patient involvement in planning services for the practice population.
• The provider was aware of the requirements of the duty of candour.
• We saw evidence that patients were not always fully informed when they were affected by a significant event.

The areas where the provider must make improvement are:

• The provider must do all that is reasonably practicable to assess, monitor, manage and mitigate risks to the health and safety of patients who use services. Safety alerts must be acted on, and notifications of incidents must be made in a timely manner. Processes for keeping patients informed when they are affected by internal incidents must also be improved.

  In addition the provider should:

• Take steps to improve uptake of bowel and breast screening amongst the practice population.

• Continue to develop and maintain a carers’ register, and offer additional support to this group of people.

• Continue to support patients wishing to make complaints, verbal or written.

• Continue to improve systems and processes for monitoring patient outcomes.

• Establish a clear safeguarding lead within the practice, ensure all staff are aware of who this is; and develop systems for multidisciplinary meetings to be held in house.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice