At our previous announced comprehensive inspection of Vanbrugh Group Practice on 15 August 2017 the overall rating for the practice was good. The provider was rated as good for providing effective, caring, responsive and well-led services and requires improvement for providing safe services. The full comprehensive report of the inspection can be found by selecting the ‘all reports’ link for Vanbrugh Group Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 February 2018 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 at our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection, carried out on 13 February 2018, we found that the provider had addressed all the issues identified at the previous inspection. The provider was now meeting the requirements of the regulations. Overall the practice is rated as Good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The system now included the detailed identification and recording of all learning outcomes resulting from investigations carried out.
• The practice had systems in place to minimise risks to patient safety. These now included a comprehensive cold chain policy which included the action staff should take if fridge temperatures fell outside of the recommended range and the regular checking of emergency equipment and medicines.
• A process was in place to monitor that results were received for all cervical screening samples sent for testing. Inadequate sample rates were routinely monitored.
• A new process had been introduced to check that all patients referred under the two-week wait process received an appointment within the required timescale.
• The practice had addressed the issue of a large number of records awaiting coding by revising the criteria for coding to ensure it was now selective and by allocating additional administrative time to carry out the task.
• There was now a reliable process for checking uncollected repeat prescriptions. This process included a monthly check by the prescription clerk when uncollected prescriptions were passed to a GP for review and action taken where necessary.
• At the previous inspection we noted that patient satisfaction rates regarding the ease with which they were able to get through to the practice by telephone were below the CCG and national averages. Since the previous inspection the provider had installed a new telephone system and had employed two additional members of reception staff to help reduce the pressure at key times.
• At the previous inspection we saw that privacy of communication at the reception desk was limited due to the open-plan aspect of the reception and waiting area. Since the previous inspection the provider had rearranged the seating to ensure patients were not sitting close to the reception desk and had installed background music so that conversations at the desk were less audible.
• Staff reported that patients had been giving very positive feedback regarding the new telephone system and introduction of music in the waiting area.

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 Vanbrugh Group Practice on 15 August 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the system was not effective in identifying and recording all learning outcomes resulting from investigations carried out.
• The practice had embedded systems to minimise risks to patient safety. However, the cold chain policy did not include the action staff should take if fridge temperatures fell outside of the recommended range and there was no consistent process in place to ensure results were received for all cervical screening samples sent for testing and inadequate sample rates were not routinely monitored.
• There was no fail-safe procedure in place to ensure appointments were received for all patients referred under the two-week wait process.
• Although correspondence was actioned by GPs within appropriate timescales there was a large amount of correspondence awaiting coding and linking to patient electronic records.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• There was a reliable process for producing repeat prescriptions. However uncollected prescriptions were only checked and actioned six-monthly.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patient satisfaction rates regarding the ease with which they were able to get through to the practice by phone were below the CCG and national average.
• Patients we spoke with said they were usually able to make an appointment with a named GP and urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However, the procedure for checking emergency medicines and equipment was ad hoc and informal.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

There were areas where the provider must make improvements. The provider must ensure care and treatment are provided in a safe way:

• The provider must ensure there is an effective procedure in place to inform staff of the action to take if fridge temperatures fall outside of the recommended range.
• The provider must ensure a consistent process is in place to ensure results are received for all cervical screening samples sent for testing and to monitor inadequate sample rates.
• The provider must ensure that correspondence awaiting coding and linking to patient electronic records is processed within acceptable timescales.
• The provider must ensure that significant event records include all relevant details and that learning and necessary improvements are identified and implemented.
• The provider must ensure that uncollected repeat prescriptions are checked on a frequent basis to ensure action is taken, where necessary, within safe timescales.

The areas where the provider should make improvement are:

• The provider should continue to monitor patient satisfaction rates regarding the ease with which patients are able to get through to the practice by telephone and implement improvements as appropriate.
• The provider should consider implementing an effective process to ensure regular checking of emergency equipment and medicines.
• The provider should consider implementing an effective fail-safe procedure to ensure appointments are received for all patients referred under the two-week wait process.
• The provider should consider ways of improving the privacy of communication at the reception area.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice