Letter from the Chief Inspector of General Practice

We carried out an announced, comprehensive inspection at The Sorsby Medical Practice on 29 November 2016. The overall rating for the practice was ‘good’ overall but was rated ‘requires improvement’ for providing caring services. The full comprehensive report on 29 November 2016 inspection can be found by selecting the ‘all reports’ link for The Sorsby Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 13 September 2017 to confirm that the practice had carried out their plan to make improvements to their service in relation to the concerns that we identified in our previous inspection on 29 November 2016. This report covers our findings in relation to those additional improvements made since our last inspection.

Overall the practice is now rated as ‘good’ overall and ‘good’ for providing caring services.

Our key findings were as follows:

• The practice had monitored patients’ experience of the service and made changes to improve patients’ experiences.

• The changes made had resulted in some improved results in the National GP Survey; we were satisfied that the practice was committed to on going improvements that should increase patient satisfaction over the longer term.

However, there was also one area of practice where the provider needs to make improvements.

The provider should:

• Continue to monitor the appointments system to drive improvement in the quality of access for patients and communicate effectively with patients around changes to the appointments system.

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 Sorsby Medical Practice on 19 February 2015. While the practice was rated good overall, the question Are services safe? was rated requires improvement. The full comprehensive report on the February 2015 inspection can be found by selecting the ‘all reports’ link for The Sorsby Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 29 November 2016. Overall the practice is rated as good.

Our key findings were as follows:

• The provider had met the requirement notice we issued at the February 2015 inspection and was compliant with the regulation: recruitment procedures had been established and were operated effectively to ensure fit and proper persons were employed.National GP survey results showed patients were less likely to be treated with compassion, dignity and respect, to be involved in their care and decisions about their treatment, and to find it easy to make an appointment. The provider was taking action to address these findings.
• NHS England had awarded the provider a seven year contract in November 2015, ending five years of uncertainty and enabling the provider to take the practice forward on a secure footing. Staff morale was improving and the provider was increasing capacity and making strategic changes to the practice to improve patients’ experience of the service.
• 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 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.
• 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 well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvement is:

• Continue to monitor patients’ experience of the service to check that the changes being made are working and reflected in the National GP Patient Survey.

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 Sorsby Medical Practice on 19 February 2015. Overall the practice is rated as Good. The practice is run by the Lower Clapton Group Practice nearby, which is separately registered with the Care Quality Commission and was not visited as part of this inspection.

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

We found the practice requires Improvement for providing safe services.

Our key findings were as follows:

• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
• The practice promoted good health and prevention and provided patients with suitable advice and guidance.
• The practice had several ways of identifying patients who needed additional support, and was pro-active in offering this.
• The practice provided a caring service. Patients indicated that staff were caring and treated them with dignity and respect. Patients were involved in decisions about their care.
• The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
• The practice learned from patient experiences, concerns and complaints to improve the quality of care.

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

Importantly, the provider must:

• Ensure patients are fully protected against the risks associated with the recruitment of staff, in particular in the recording of recruitment information and in ensuring all appropriate pre-employment checks are carried out and recorded prior to a staff member taking up post.

In addition the provider should:

• Ensure the records of child protection training are available for all staff.
• Arrange for all staff to complete formal training in safeguarding of vulnerable adults.
• Take steps to communicate the practice’s chaperone policy more clearly to patients in clinical areas.
• Ensure the recommendations of the recent PHE report on cold storage of medicines are implemented and the policy for ensuring medicines are kept at the required temperatures is followed at all times.
• Arrange infection control update training for all staff who need this and ensure records are available for staff who have completed the training.
• Implement a planned schedule of fire evacuation drills and arrange fire safety update training for all staff.
• Review the practice’s consent protocol to ensure mental capacity is appropriately taken into account.
• Continue to pursue action to make further improvements in disabled access to the practice.
• Take further steps to address dissatisfaction raised by patients about continuity of care, access to appointments and waiting times.
• Arrange for information about the complaints procedure to be made more readily available to patients in the waiting area; and review the procedure document to ensure references to other agencies is up to date and accurate.
• Ensure the practice’s whistleblowing policy is up to date and staff are made aware of it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with two doctors, the practice nurse, a receptionist and the two practice managers. We also spoke with seven people who used the service and the chair of the practice's patient participation group.

The patients we spoke with said they were happy with the service and had seen improvements. One patient said, “it’s pretty good and it’s getting better. It’s like a proper family doctor now.” Patients told us the staff were friendly and respected their privacy. We saw that the environment was clean but the premises were in need of refurbishment.

Staff told us they were well supported by their managers and the GP partners. We saw evidence of staff training and were told that the practice manager and doctors were approachable and always happy to discuss any issues.

The practice had a range of quality monitoring systems in place including an active patient participation group. The practice team conducted audit and used data about performance, incidents, comments and complaints to improve the quality and safety of care.