This practice is rated as Good overall. (February 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

In 2016, we carried out a focused inspection to review the actions taken by the provider as a result of our issuing one legal requirement at the previous comprehensive inspection. The practice had introduced systems to mitigate risk by improved reporting and investigation of incidents involving medicines.

At this inspection in May 2018, we found:

• The practice had embedded and introduced new systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had implemented an IT system, which searched patient records to prompt audit and target regular reviews of patients to reduce health risks for them.
• Effectiveness and appropriateness of patient care was closely monitored by the strengthened governance arrangements put in place since the last inspection. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Feedback from all 30 patients at the inspection was strongly positive, and verified staff involved treated them with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. Patients needing urgent appointments were seen rapidly by the duty GP on the same day. Routine appointments for both GPs and nurses were available within two day.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice had recommenced providing teaching placements for medical students.
• The practice had a strong focus on continuity of care with personal GP lists.

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Torrington Health Centre on 16 August 2016. This was to review the actions taken by the provider as a result of our issuing one legal requirement. In February 2016, the practice did not do all that is reasonably practicable to mitigate risk. This was specifically about the reporting and investigation of incidents involving medicines so that action was taken to remedy the situation, prevent further occurrences and make sure that improvements were made as a result. The practice sent us a plan showing how these issues would be addressed and we have monitored this with the practice. At this inspection, we reviewed the actions taken since the last inspection.

This report covers our findings in relation to the regulations and should be read in conjunction with the report published on 29 April 2016. This can be done by selecting the 'all reports' link for Torrington Health Centre on our website at www.cqc.org.uk

Overall the practice has been rated as GOOD following our findings, with the safe domain now rated as GOOD.

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

• The provider had introduced systems to ensure that incidents involving medicines were reported internally and to relevant external authorities/bodies.

• A practice wide system for reviewing and investigating all incidents, including those arising in the dispensary had been implemented. Examples seen demonstrated that these were thoroughly investigated by competent staff. Actions had been taken to remedy the situation, prevent further occurrences and made sure that improvements were made as a result. 

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 Torrington Health Centre on 11 February 2016. Overall the practice is rated as good.

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

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff enjoyed their work and told us that the culture at the practice was open and supportive.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data showed patient satisfaction outcomes with GP consultations were improving since national survey results published in July 2015.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice 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.
• Three clinical audits had been carried out, which were driving improvement in performance to improve patient outcomes.
• Information about services was available and there were effective approaches to provide information for patients. For example via the practice website, through a printed patient newsletter and through the use of pictorial and easy to read information for patients with learning difficulties.

The areas where the provider must make improvement are:

Action the provider MUST take to improve:

• Ensure a robust procedure is in place to record and learn from errors and near misses across both dispensaries.

The areas where the provider should make improvement are:

Action the provider SHOULD take to improve:

• Review oxygen cylinder storage for safety and security.
• Review how all Patient Group Directions are adopted for use in the practice.
• Consider how staff meetings are used to promote inclusiveness within the staff team.
• Review how meeting minutes records are completed to ensure accuracy.
• Review the staff training planning to ensure gaps in mandatory training refresher sessions are avoided.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• Re-audit within audit cycles where overdue.
• Review how carers are identified and recorded on the patient record system to increase awareness of carers on the practices’ patient list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice