Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Circle Practice on 5 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, caring, responsive and well led services. It was also good for providing services for older people; families, children and young people; working age people (including those recently retired and students); people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia). It required improvement for providing effective services and services for people with long term conditions.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Systems including safeguarding measures and infection control procedures were in place to keep patients safe.

• Staff were appropriately qualified to deliver effective care and treatment in line with professional guidelines.

• 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.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• 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.

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

Importantly the provider must:

• Ensure Disclosure and Barring service (DBS) checks are undertaken for all staff who undertake chaperone duties at the practice or undertake a risk assessment if a decision is made not to perform DBS checks for staff providing chaperone duties.

The provider should:

• Ensure all staff providing chaperone duties understand their role and responsibilities when providing the chaperoning service.
• Ensure all patients with long term conditions are provided with a structured annual review to check that their health and medication needs are met.
• Ensure there is a proactive recall system in place to provide preventative and continuing care for patients.
• Ensure the practice business continuity plan provides a comprehensive list of contact details for staff to refer to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection February 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

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 The Circle Practice on 10 May 2018. The inspection was carried out to follow-up on a breach of regulations identified at our previous inspection. At this inspection we found:

• The practice had systems to manage most risks so that safety incidents were less likely to happen.
• We did find some safety risks however. For example, the practice was not ensuring the health care assistant was administering vaccinations with valid authorisation.
• When incidents occurred, 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 easy to use and reported that they could access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• The practice must ensure that care is provided in a safe way to patients. This includes ensuring that medicines administered by the health care assistant are done so under valid patient specific directions authorised by a prescriber; ensuring it has an effective system to maintain the temperature of vaccines and any other medicines that require refrigeration. The practice must review its contribution to cervical screening failsafe arrangements and audit the sample takers’ rate of inadequate samples.

The areas where the provider should make improvements are:

• The practice should continue to review its child immunisation performance and take action where appropriate to meet the national target.
• The practice should review how it assures itself that all healthcare professionals working at the practice maintain their registration with the appropriate professional body.
• The practice should review its infection prevention and control arrangements and clarify roles and responsibilities with all staff members.
• The practice should review the programme of immunisation status checks and vaccination schedule offered to new staff members.
• The practice should ensure it maintains an accurate register of patients with learning disabilities so that services can be appropriately tailored to these patients’ needs.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice