Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Charlbury Medical Centre on 24 August 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect, but were not always satisfied with access to appointments or the time and attention that clinicians were able to provide.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• The practice was equipped to treat patients and meet their needs. However, it did not have an automatic entrance door or hearing loop to assist patients.
• 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. Annual appraisals were not provided, although staff members told us that they felt that their development needs were fully met through other avenues.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice was responsive to the needs of its population, which was geographically isolated from many other medical services, through provision of a dispensary delivery service and close working with the local district nurse team.

The areas where the provider must make improvement is:

• Ensure that all staff have an appraisal by March 2017, and that annual appraisals take place thereafter.

In addition, the provider should:

• Ensure the fridges which store medicines are effectively monitored.

• Ensure the security of blank prescriptions whenever consulting rooms are left unattended.

• Establish an audit trail to ensure that medicine and equipment safety alerts are acted on by clinicians.

• Ensure that the practice premises meets accessibility expectations for patients with disabilities through the installation of an automatic entrance door and a hearing loop.

• Continue to work to improve patient satisfaction through patient feedback and complaint analysis to ensure it meets the needs of the patients and the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to Charlbury Medical Centre we met with the registered manager, who was also the practice manager, and with two GPs. We spoke with five patients and with three members of staff.

Patients told us they were given explanations of their care and treatment which they understood. One patient we spoke with said the explanations they received about their treatment were "always very helpful".

Patients were happy with the care and treatment they received. One patient said "the service here is impeccable. I got an appointment this morning having called at 8 a.m.”. Care and treatment was planned with regard to patient welfare and safety. One patient we spoke with said "I have a diabetic check twice a year. The reminder for the check is on my prescription slip”.

There were effective systems in place to manage medicines. One patient we spoke with said "you get a medicine review reminder on your prescription. If you are a bit late they (the member of staff who processed prescriptions) highlights it”.

Staff were happy in their roles and felt well supported to do their job. A member of staff told us "I love it here. I love the patients and I love the staff I work with. The GPs here are very supportive".

We saw that the practice used patient feedback to influence the way services were delivered. We saw that early morning appointments with the practice nurses had been introduced because some patients had requested access to earlier appointments.

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at The Charlbury Medical Centre on 24 August 2016 found breaches of regulations relating to staffing. The overall rating for the practice was good, but the practice was rated requires improvement in the effective domain. The full comprehensive report from the August 2016 inspection can be found by selecting the ‘all reports’ link for The Charlbury Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused desktop inspection (we have not visited the practice but requested information to be sent to us) carried out on12 April 2017. The inspection was conducted to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. The information requested in April 2017 identified that the practice was meeting the regulation that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. In addition the practice made improvements to its services where we suggested this could improve services for patients.

Our key findings were as follows:

• A programme of appraisal had been followed and staff received appraisals to ensure their development and learning needs were met. This provided staff with the opportunity to enhance their learning and development.
• In addition to the regulatory breach, actions were taken where we suggested the provider should consider our findings. For example:
• Hearing loops have been installed in the reception area and the dispensary to aid patients with impaired hearing.
• Printers that contain prescriptions now have tray locks to prevent unauthorised access
• In response to patient feedback, evening appointments on a rota basis with the other practices were made available to patients.
• New temperature recording equipment for fridges were purchased to ensure they were effectively monitored. This ensured the storage of medicines in the fridges was safe.
• A process for disseminating medicine safety alerts to staff was introduced, with records available in a folder should staff need to access them for information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice