At our previous comprehensive inspection at Wye Valley Surgery in Buckinghamshire on 2 November 2017 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was requires improvement. Specifically, the practice was rated requires improvement for the provision of safe and responsive services.

The concerns which led to these ratings apply to everyone using the practice, therefore all population groups were also rated requires improvement. The practice was rated good for the provision of effective, caring and well-led services.

The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Wye Valley Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 March 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 in November 2017.

This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 21 March 2018 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well-led services. Overall the practice is now rated as good.

All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

• Systems had been implemented and embedded which ensured care and treatment was provided in a safe way to patients.

• The practice had established and was now operating safe and effective systems to assess, manage and mitigate the risks identified relating to patient safety, medicine safety and device alerts.

• The practice had continued to review the existing arrangements with regards to the number of patients attending the cervical screening programme. Part of the review included an analysis of potential barriers preventing patients attending the screening programme. We also saw the review led to a five point action plan to increase uptake rates. We were presented data during the March 2018 inspection which indicated the plan had been effective and uptake rates had increased.

• The practice engaged with patients and monitored the outcomes of patient feedback including patient surveys and took appropriate action to further improve the patient experience. Feedback received during the inspection indicated improving levels of patient satisfaction, specifically regarding access.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall.

At our previous inspection in April 2015 the practice had an overall rating as Requires Improvement. We carried out a desktop follow up inspection in January 2016 to ensure improvements had been made and to review if the service was meeting regulations. We found the practice had made improvements and as a result we updated the overall rating to Good.

Following the November 2017 inspection, the key questions are rated as:

• Are services safe? – Requires improvement

• Are services effective? – Good

• Are services caring? – Good

• Are services responsive? – Requires improvement

• 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 – Requires improvement

• People with long-term conditions – Requires improvement

• Families, children and young people – Requires improvement

• Working age people (including those recently retired and students – Requires improvement

• People whose circumstances may make them vulnerable – Requires improvement

• People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Wye Valley Surgery in High Wycombe, Buckinghamshire on 2 November 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Wye Valley Surgery was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had clear 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 defined and embedded systems, processes and practices to minimise risks to patient safety. However, we found these systems had not monitored patient safety alerts.

• Staff had received training appropriate to their roles and the population the practice served. Any further training needs had been identified and planned.

• Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

• We received positive feedback from external stakeholders and patients who access GP services from the practice.

• Patient feedback regarding access was improving, however, results from the most recent national GP survey shows satisfaction for access to appointments was still lower when compared to local and national averages.

• The practice learned lessons from individual concerns and complaints and also from analysis of trends. For example, telephone access had been a historic concern within the practice. As a result, the practice reviewed the telephone system and invested in a new cloud based digital system to support improvements to telephone access.

• The practice had clear and visible clinical and managerial leadership and supporting governance arrangements.

• There was a strong focus on continuous learning and improvement within the practice and local community. For example, the practice told us they were negotiating new modern premises with the aim of creating a Primary Care Hub within the town centre.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients. For example, ensure safety alerts are received into the practice and implement a system to ensure they are acted upon. Thus ensuring there is a review of all patients that may have been affected by the safety alerts.

The areas where the provider should make improvements are:

• Continue to review the number of patients attending the cervical screening programme, with a view to increase uptake rates.

• Continue to seek feedback and improve engagement with patients and patient participation group whilst reviewing the outcomes of patient feedback including patient surveys to determine appropriate action with a view to improving the patient experience.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

On the day of the inspection we spoke with twelve patients and a patient questionnaire was sent out. Patients told us they were treated with respect and dignity. They told us they felt involved in making decisions about their care and treatment. One patient told us their GP listens to them and what they have to say and felt involved in the treatment. Another patient told us “They give you time to explain and they treat us very well.” Comments from the patient questionnaire, where patients were asked if the GP and Nurse involved them in their care, responses included, “Yes. I am asked if I am happy with the treatment and if I have any questions”, “Yes options are always explained” and “Yes and explains it all.”

Patients told us they were satisfied with the care and treatment they received from the GP’s and the nurses. One patient told us “GPs explain treatment option and side effects… support is brilliant in sensitive cases.” Another patient said “…Some GPs are relaxed and you feel free to talk to them. Some are very sympathetic.” However, the practice did not have appropriate arrangements in place to deal with emergencies.

Patients we spoke with told us they were well supported by all staff and they felt safe when they visited the practice. However, Patient's who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the practice did not have a robust recruitment process in place putting patients at risk, as complete and thorough checks and not been completed to fully establish the persons suitability for the role.

Patients we spoke with told us they had not had a need to make a complaint and told us they knew how to make a complaint if needed to. One patient told us “I have not made any complains yet but if I have to I will do.”

Letter from the Chief Inspector of General Practice

During a comprehensive inspection of Wye Valley Surgery in April 2015 we found concerns related to the review of patients with long term conditions, care plans for patients suffering poor mental health, lower than average cancer detection rates and poor patient experiences regarding telephone access. Improvements were required to be made in caring for people with long-term conditions, people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). Because of these concerns, we found the practice in breach of regulations relating to effective and responsive care and delivery of services.

Following the inspection, the practice sent us an action plan detailing how they would improve the uptake rate for patients with long term conditions, formulate comprehensive care plans for patients suffering poor mental health, make improvements to cancer detection services and enhance telephone access.

We carried out a desktop review of Wye Valley Surgery on 25 January 2016 to ensure these changes had been implemented and that the service was meeting regulations. The ratings for the practice have been updated to reflect our findings. We found the practice had made improvements in effective care and for their population groups since our last inspection on 15 April 2015 and they were meeting the requirements of the regulation in breach.

Specifically the practice had;

• Improved the care of patients with long term conditions by offering them an annual review.

• Improved the care of patients suffering poor mental health through the increased provision of care plans.

• Worked collaboratively with NHS England and Thames Valley and Cancer Research UK to improve detection rates and admission avoidance.

• Invested in a new telephone system to improve access.

We have offered new ratings for this practice to reflect these changes. The practice is rated good for the provision of effective services and requires improvement for responsive services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice