Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Courtyard Surgery on 17 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for The Courtyard Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Significant events were discussed at practice meetings. The outcomes and learning from these meetings was shared with staff.
• Systems were now in place for receiving and disseminating information on patient safety alerts.
• Staff appraisal records now included continual professional development records.
• Training and induction records for clinical and non-clinical staff were in place and up to date. Gaps in training had been addressed.
• Systems were in place to record, respond to and learn from complaints and concerns.

Additionally:

• The practice had reviewed the low patient satisfaction scores in respect of involving patients in decisions. We were told that GPs had taken on this feedback and were aware of the need to ensure patients were involved and treatments explained. We saw draft advice leaflets being developed by the practice to assist with explaining test results. The last patient survey showed that 87% of respondents stated the last GP they saw was good at involving them in decisions compared to the previous survey result of 76%.
• The practice reviewed their carers list and undertook an exercise to ensure all known carers were identified as carers in the clinical system. The practice manager told us that every opportunity was taken to check carer status. For examples patients were asked at the point of registration, during self-check-in and appointments. The current figure was 0.9% of the practice population. The practice had a care co-ordinator who kept this under review.
• The practice had reviewed their approach to bereavement and a protocol had been put in place with a copy on display in the reception area. GPs made contact with the family or carers and where appropriate a letter of condolence was sent.

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

The provider should:

• Review the current arrangements for storing information on complaints to ensure this is readily available for review.
• Review the arrangements for transferring data between the two practices to ensure this meets data protection and information governance policies.

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 The Courtyard Surgery on 17 January 2017. Overall the practice is rated as requires improvement.

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

• Although risks to patients were assessed, the systems to address these risks were not always implemented well enough to ensure patients were kept safe. For example in relation to MHRA medicines alerts not being identified or actioned in a timely way.
• Safeguarding processes were in place and staff understood their responsibilities in relation to this, however not all clinical staff had attended child safeguarding training at the appropriate level.
• Medicines were well managed and blank prescriptions were stored safely, however monitoring of the distribution of prescriptions was not in place.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough and lessons learned were not communicated widely enough to support improvement.
• There was no system for the adoption of national guidelines within the practice or evidence of reference or discussion at relevant meetings.
• Induction and training records were incomplete and some training records appeared to show when policies had been read rather than actual training attendance.
• Appraisals were in place but personal development plans were not developed as a result.
• Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and satisfaction was high with the exception of patient satisfaction with how GPs involved patients in decisions about their care and treatment which was lower than average.
• The practice had only identified 0.8% of the practice population as carers which was below average.
• There was no practice wide approach to making contact with or providing support to families following a bereavement.
• There was limited evidence that learning from complaints had been shared with staff and records of written responses and investigations were not comprehensive.
• Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.
• Clinical audits demonstrated quality improvement.
• The practice had a number of policies and procedures to govern activity.

The areas where the provider must make improvements are:

• Investigate safety incidents thoroughly and ensure that records reflect learning and that this is shared with staff.
• Ensure complaints are appropriately responded to, that records are maintained of all aspects of complaints management and that these are discussed and addressed in a timely way.
• Ensure that training records are maintained and that staff attend regular updates for training appropriate for their role, including child safeguarding, fire safety and infection control.
• Ensure that all new staff receive a comprehensive induction and that records are maintained.
• Ensure that logs are kept of the distribution of prescriptions within the practice and that these are appropriately monitored.
• Ensure that a system for monitoring and acting on patient safety alerts and NICE guidance is embedded within the practice and that records are kept to demonstrate this.

In addition the provider should:

• Review patient satisfaction with how GPs involved them in decisions about their care and treatment.
• Take action to improve the identification of carers within the patient population group.
• Establish a practice wide approach to making contact with or providing support to families following a bereavement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice