We previously carried out an announced comprehensive inspection at Arrow Surgery on 28 April 2016. Following this inspection, we rated the practice as good overall and good for all population groups.

We carried out an announced comprehensive inspection at Arrow Surgery on 29 November 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines and best practice.
• There were comprehensive policies and procedures to support best practice.
• There was an open and transparent approach to safety and a system in place for recording, reporting and learning from significant events. 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.
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse and for identifying and mitigating risks to health and safety.
• There were clear responsibilities, roles and systems of accountability to support effective governance.
• Patients received effective care and treatment that met their needs.
• The most recently available National GP Patient Survey results were consistently above the national average for the areas we looked at.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Arrow Surgery on 28 April 2016. Overall the practice is rated as good.

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

• The practice used an effective system for reporting and recording significant events. It took a transparent, open approach to safety.
• Staff effectively assessed and managed risks to patients.
• The practice used current evidence based guidance to assess patients’ needs and deliver care. Training was provided to staff to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with respect and they were impressed with the professional standard of care they had received.
• Details of services and information about how to complain were clearly displayed and easy to understand. Complaints and concerns were analysed and used to improve the quality of care provided.
• Patients told us they found it easy to make an appointment with their named GP and that urgent appointments were available the same day.
• The practice had modern facilities which met patients’ needs.
• The practice had a clear leadership structure and management supported staff to carry out their roles. The practice asked staff and patients for input and was proactive in adopting changes.
• The practice was familiar with the conditions of the duty of candour and exercised an open and honest culture.

We saw one area of outstanding practice:

• The practice’s lead for end of life care lead had introduced a structured approach to identifying patients nearing the end of life and looking at their individual needs and wishes. As a result the number of patients on their end of life register had increased from just five in 2011, to 75 in 2016. The practice told us this allowed them to plan a better experience for patients and their carers during the last days of their lives. The practice was able to evidence the positive outcome this had had for patients as people were more likely to be able to die at home if this was their preference. During 2015 the practice had recorded that 54% of patients who had died were on their end of life register. This represented a total of 18 patients, 14 of whom had been able to die in their preferred place.

The areas where the provider should make improvement are:

• The practice should review and strengthen its overall system for monitoring responses to safety alerts to ensure that any required actions are addressed.

• The practice should keep a written record of verbal information they obtain about job applicants to confirm they have obtained satisfactory evidence of conduct in relevant previous employment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice