Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We carried out an announced comprehensive inspection at Silver End Surgery on 17 January 2018 as part of our inspection programme.

At this inspection the key findings were as follows:

• Staff could identify and respond appropriately to patients that developed deteriorating health or medical emergencies.

• The practice had reliable systems for appropriate and safe storage of medicines.

• The practice took steps to maintain the safety of the working environment.

• We were not assured that the practice learned or shared action taken to improve safety when serious incidents or significant events should have been investigated.

• Patients care treatment and support achieved positive outcomes because delivery was based on the best available evidence.

• The practice monitored and reviewed the effectiveness and appropriateness of medical annual reviews. When identified reviews had not taken place, action was taken to contact patients.

• Not all appropriate staff had undertaken Mental Capacity Act training.

• Patients received coordinated care, were assisted to live healthier and gave consent when required. However, multi-disciplinary meetings were not taking place.

• The practice had a process to follow up failed attendance of children’s appointments following a referral or an appointment to secondary care or for immunisation.

• Patients were supported, treated with dignity and respect, and were involved as partners in their care.

• The practice proactively identified patients that were carers and offered them extra support.

• The importance of flexibility, informed choice and continuity of care was reflected in the practice.

• Staff booking home visits were aware how to escalate patients describing urgent medical conditions that may require a more urgent response.

• When patients raised complaints or concerns, the practice did not always consider their views, investigate them thoroughly or change practice to improve.

• Leadership and governance required strengthening in some areas.

• There was a corporate process to review key items such as the strategy, values, objectives, plans and governance framework; however, this was not being consistently applied at the practice.

• Some audits had been carried out however, there was no programme for regular audits or other quality assurance for the service that would assess, monitor and improve the quality of the services provided.

• The practice had responded to an area of low data in the national GP patient survey and were looking at ways of improving patient satisfaction.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Ensure appropriate staff receive relevant training on the Mental Capacity Act.

• Undertake multi-disciplinary meetings with other healthcare professionals and ensure record keeping is maintained.

• Continue to monitor and improve patient satisfaction in relation to waiting times.

• Implement a quality assurance programme that includes undertaking clinical audits.

• Improve the cascading of information to staff from team meetings to ensure that staff are aware of issues affecting practice performance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice