Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Walton Surgery on 16 June 2015. The practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe, effective and well-led services and good for providing a caring and responsive service.

In particular, on 16 June 2015, we found the following areas of concern:

• There was no audit trail that reflected that following incidents or concerns being raised improvement action had been taken.
• Infection control audits were not being carried out in line with recommended timescales.
• Risk relating to the management of medicines, medicines alerts, prescription reviews and stocks of emergency medicines were not being assessed.
• A legionella risk assessment had not been carried out.
• Reception staff acting as chaperones had not received a disclosure and barring service (DBS) check.
• Staff were unclear which training they were expected to undertake and when it was due.
• Annual appraisals had been undertaken for clinical staff but not for administration staff.
• Data showed patient outcomes were average for the locality but where the Quality and Outcomes Framework was not being used there was no other performance measure in place.
• The practice had not sought views from patients in the form of a survey or by other means.

As a result of our findings at this inspection we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the inspection on 16 June 2015 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

We carried out a further comprehensive inspection at Walton Surgery on 23 November 2016 to check whether the practice had made the required improvements. We found that the majority of the improvements had been made across all areas of concern. Overall the practice is now rated as good.

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

• Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
• The practice assessed risks to patients and staff. There were systems in place to manage these risks.
• Processes and systems around medicines management kept patients safe.
• Staff used current guidelines and best practice to inform the care and treatment they provided to patients.
• All patients said that they were treated with dignity and respect and involved in decisions about their care and treatment.
• There was a clear and effective complaints system in place.
• Patients had mixed views regarding access to appointments. Getting through on the telephone in the morning was identified as an issue by some patients. Others told us that access to same day appointments was good.
• The practice had difficulty recruiting GPs to the practice and had reviewed the way it provided clinical services to meet the needs of its patient population.
• There was a strong leadership structure in place and staff were supported to increase their knowledge and skills. Appraisals for non-clinical staff were not taking place, however we saw evidence that they still had access to training and career progression. 
• There was an open and transparent approach evident throughout the practice. The practice management were aware of both their strengths and areas for improvement and had incorporated this into their planning for the future.

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

The provider should:

• Provide non-clinical staff with regular performance appraisals.
• Improve access to appointments via telephone.
• Improve the monitoring of patients with poor mental health.

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 at Walton Surgery on 16 June 2015. The practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe, effective and well-led services and good for providing a caring and responsive service.

In particular, on 16 June 2015, we found the following areas of concern:

• There was no audit trail that reflected that following incidents or concerns being raised improvement action had been taken.
• Infection control audits were not being carried out in line with recommended timescales.
• Risk relating to the management of medicines, medicines alerts, prescription reviews and stocks of emergency medicines were not being assessed.
• A legionella risk assessment had not been carried out.
• Reception staff acting as chaperones had not received a disclosure and barring service (DBS) check.
• Staff were unclear which training they were expected to undertake and when it was due.
• Annual appraisals had been undertaken for clinical staff but not for administration staff.
• Data showed patient outcomes were average for the locality but where the Quality and Outcomes Framework was not being used there was no other performance measure in place.
• The practice had not sought views from patients in the form of a survey or by other means.

As a result of our findings at this inspection we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the inspection on 16 June 2015 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

We carried out a further comprehensive inspection at Walton Surgery on 23 November 2016 to check whether the practice had made the required improvements. We found that the majority of the improvements had been made across all areas of concern. Overall the practice is now rated as good.

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

• Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
• The practice assessed risks to patients and staff. There were systems in place to manage these risks.
• Processes and systems around medicines management kept patients safe.
• Staff used current guidelines and best practice to inform the care and treatment they provided to patients.
• All patients said that they were treated with dignity and respect and involved in decisions about their care and treatment.
• There was a clear and effective complaints system in place.
• Patients had mixed views regarding access to appointments. Getting through on the telephone in the morning was identified as an issue by some patients. Others told us that access to same day appointments was good.
• The practice had difficulty recruiting GPs to the practice and had reviewed the way it provided clinical services to meet the needs of its patient population.
• There was a strong leadership structure in place and staff were supported to increase their knowledge and skills. Appraisals for non-clinical staff were not taking place, however we saw evidence that they still had access to training and career progression. 
• There was an open and transparent approach evident throughout the practice. The practice management were aware of both their strengths and areas for improvement and had incorporated this into their planning for the future.

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

The provider should:

• Provide non-clinical staff with regular performance appraisals.
• Improve access to appointments via telephone.
• Improve the monitoring of patients with poor mental health.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with seven people, all of whom gave positive responses about how their care and treatment was assessed and planned. One person told us, “They are always happy to answer questions and discuss the options.”

We found that before people received any care or treatment they were asked for their consent and the clinicians acted in accordance with their wishes. One person we spoke with said, “They ask for my consent before an intervention and if you say no they don’t push you.”

We saw that the surgery worked proactively with a range of other providers including audiology and end of life care professionals. One person we spoke with told us, “I was referred to hospital as an emergency. It happened smoothly and I felt well looked after.”

We spoke with five members of staff, all of whom felt well supported. We spoke with two nurse practitioners who told us, “Either of us is always here, so that staff have someone to come to.”

We saw that the surgery had an effective system in place to assess and monitor the quality of the service and ensured that information was shared with people who used the surgery. One person we spoke with told us, “It’s a good practice, even under the pressure, with the shortage of GPs.”