Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Attenborough Surgery on 18 January 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 an effective system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
• Risks to patients were assessed and managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The patients we spoke with or who left comments for us were positive about the standard of care they received and about staff behaviours. They said staff were courteous, efficient, supportive and professional. They told us that their privacy and dignity was respected and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult and there could be a considerable wait to see a GP of their choice when making a pre-bookable appointment. However, those patients said access to urgent and same day appointments was good.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

• The practice demonstrated an overarching approach to continuous quality improvement. For example, members of staff at the practice had received a NHS innovation award for their work on responsible antibiotic prescribing in primary care (specifically in the management of acute lower respiratory tract infection). During the study/trial period we saw that the prescribing of antibiotics on patients’ initial presentation reduced from 31% in the winter of 2014/2015 to 8% in the same three month period during the winter of 2015/2016. Unscheduled follow ups within 28 days for patients who were not prescribed antibiotics reduced by more than 50%. Due to its success, funding was available for the work to spread across the locality and nationally and this was ongoing at the time of our inspection.

The areas where the provider should make improvements are:

• Ensure that hand wash facilities at Prestwick Road Surgery meet the required specifications.
• Take steps to ensure that hot water temperatures at the practice are kept within the required levels and a comprehensive water temperature checking process is in place.
• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including safeguarding adults, infection prevention and control and basic life support training.
• Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are monitored and improved, including access to appointments.
• Ensure that at Prestwick Road and Carpenders Park surgeries patients have access to a range of information about the services available, health promotion and access to advice and support groups.
• Continue to identify and support carers in its patient population.
• Ensure that all staff are engaged with the development and direction of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with six patients and six members of staff.

Patients told us they were spoken with respectfully by staff. A patient told us: "Everybody is extremely polite, pleasant and helpful. I have never had a problem." Patients said that staff ensured their privacy was respected when they needed an examination.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. The patients we spoke with provided positive feedback about their care. A patient said: "One of the doctors' has been amazing." Patients received their medicines when they needed them.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to so that patients were protected from harm.

We found that staff had received appropriate training for the roles they carried out. They also had regular appraisals. This meant that they had been adequately assessed regarding their competency.

The provider had a system in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.