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

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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Trinity Court Surgery on 22 February 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. The practice discussed incidents as soon as they happened, learned from them and improved their processes where necessary.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice worked collaboratively with other local practices and organisations to develop schemes which would benefit patients in the area. For example, a social prescribing pilot project had been developed with Warwickshire County Council. (Social prescribing is a way of linking patients in primary care with sources of support in the community.)
• Three GPs provided additional care out of core hours for their terminally ill patients.
• The practice participated in the South Warwickshire GP Federation’s over 75’s project, which had two elements, social prescribing and enhanced clinical reviews.
• The lead nurse won the South Warwickshire Federation’s Best Modernisation Award in 2016 for developing a template for the emergency appointment system, which made it easier for the nurse practitioner to determine whether the patient needed to be seen by a nurse practitioner or a GP.
• The practice worked with the patient participation group to provide a medicines delivery service from the branch site at Claverdon for housebound patients.
• Patients told us that the appointment system was easy to use and said that they were able to access care when they needed it.
• The practice was research accredited and encouraged patients to take part in research projects.
• There was a focus on continuous learning and improvement at all levels.

The area where the provider must make improvements as they are in breach of regulations is:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Develop a protocol for the management of patients on high risk medicines.
• Monitor the timely collection of clinical waste from Trinity Court.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Trinity Court on 31 March 2015. Overall the practice is rated as outstanding.

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

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• The practice assessed patients’ needs and planned their care following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients felt listened to and were involved in their care and decisions about their treatment. Patients described the service they received as excellent and described the staff team as professional, caring and pleasant. Information about services and how to complain was available and easy to understand.
• Patients could obtain same day appointments or book two weeks in advance (or longer in specific circumstances).
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had developed plans and a bid for funding from the Prime Minister’s Challenge Fund to enable it to respond to future patient needs.
• There was a clear leadership structure and staff felt supported by management. The practice worked closely with its patient participation group (PPG) and proactively sought feedback from staff and patients. They listened to what patients told them and made improvements accordingly.

We saw several areas of outstanding practice including:

• The practice had effective assessment, care planning and recall arrangements for patients with long term conditions. Their emergency admission rates for a number of long term conditions including diabetes, chronic heart disease and chronic obstructive pulmonary disease (COPD) were significantly below the national average. The practice also had low accident and emergency admission rates.
• The practice were involved in a project with Warwick Hospital to improve outcomes for patients with left ventricular failure (LVF), a potentially serious heart condition. They had invested in additional hours for one of the practice nurses to do this work and the nurse had completed enhanced training for this role. The project had been set up in line with a NICE initiative to improve accurate diagnosis and outcomes for patients with left ventricular failure (LVF), a potentially serious heart condition with potentially poor outcomes for patients. An early outcome of the project was that the practice had identified more patients with the condition (an increase from two to 57). The aim was to improve patients’ symptoms, avoid hospital admissions and improve life expectancy.

• The practice was working closely with its two patient participation groups (PPGs). For example, it was involving them in discussions about the practice’s bid for funding for the proposed expansion of the service. The practice also worked in partnership with the PPG which provided a medicines delivery service from the Claverdon branch surgery dispensary to patients unable to travel due to their health and mobility difficulties. This helped patients receive their medicines promptly and reduced pressure on their carers. The practice informed patients about the service and patients or their carers made specific arrangements for delivery direct with the PPG.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating July 2018 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced focused inspection at Trinity Court Surgery on 15 November 2018 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 on 22 February 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• Effective systems and processes had been established to ensure good governance in accordance with the fundamental standards of care. In particular, the system for receiving, actioning and tracking all alerts and updates had improved and was embedded.
• A written protocol for specialist drug prescribing had been introduced since the previous inspection.
• Arrangements for managing clinical waste had been strengthened and clinical waste collection was monitored.

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

Please refer to the detailed report and the evidence tables for further information.