Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Bartlemas Surgery on 26 September 2016 found breaches of regulations relating to the governance of the practice. The overall rating for the practice was good, but they were rated requires improvement in the effective domain. The full comprehensive report from the September 2016 inspection can be found by selecting the ‘all reports’ link for Bartlemas Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection visit carried out on 12 April 2017. It was conducted 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 in our previous inspection. 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. The evidence we reviewed and collected identified that the practice was meeting the regulation 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. In addition the practice made improvements to its services where we suggested this could improve services for patients.

Our key findings were:

• Improvements to diabetes care were in progress and reflected in data since our previous inspection.
• There had been a significant reduction in exception reporting in national clinical data submissions since our previous inspection.
• The process for medicine reviews had been improved and data indicated monitoring was taking place.
• Health checks for patients with learning disabilities had increased significantly.
• Guidance on obtaining consent from patients under 16 had been implemented.
• Survey data indicated the majority of patients were satisfied with access to preferred GPs.
• In the July 2016 GP national survey results the practice had a lower than average rating for seeing a GP of choice. In our last inspection report we suggested the provider should consider this. The practice undertook its own survey published in March 2017 and this showed a significant difference to the national GP survey and significantly better results in terms of access to a named GP. This indicated that of those patients to whom the question was relevant, 67% stated they found access to a GP of choice acceptable or easy. There were 326 responses to the survey.

Areas the provider should make improvements:

• Continue to improve the care for patients and performance in diabetes.

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 Bartlemas Surgery on 20 September 2016. Overall the practice is rated as good. However, improvements were required in providing effective services. Our key findings were as follows:

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

• There was a system in place for reporting and recording significant events. Reviews of complaints, incidents and other learning events were thorough.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ ongoing needs and when they delivered care to patients it was in line with current evidence based guidance.
• The practice was performing well on most clinical outcomes in terms of national data. However, national data suggested patients did not always access reviews of their conditions or meet standards of managing their care in line with national guidance. This was challenging for the practice due to their patient population. The practice had a higher proportion of patients from ethnic minority backgrounds, a transient population and the highest rate of diabetes in Oxford with over 500 patients on their diabetes register. However, national data had not been responded to in terms of driving improvement in care.
• Reviews of patients on repeat medicines were not always recorded properly to ensure this system was monitored properly.
• The practice planned its services based on the needs and demographic of its patient population.
• Staff were trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they 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 feedback in CQC comment cards suggested patients felt staff were caring, committed and considerate.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was an open culture and all staff groups were committed to the needs of the patient population. The partners included all their staff, patients and patient participation group in developing and improving the practice
• The provider was aware of and complied with the requirements of the duty of candour.
• There was an ethos of continuous learning and improvement.

Areas the provider must make improvements are:

• Identify, mitigate and improve the monitoring of patient care to ensure patients receive safe care and treatment. Specifically improve the number of patients with mental health care plans, review and identify means of improving the take up of reviews of patients with long term conditions and improve the recording of medicine reviews.

Areas the provider should make improvements are:

• Provide policy guidance to staff on the Gillick competency assessment.
• Consider installing a hearing aid loop.
• Review and take action in respect of the lower number of patients stating they could get to see their own GP in the national survey.
• Improve the uptake of learning disability reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to Bartlemas Surgery we met with two of the GPs and the practice manager. We also met with a member of the Patient Participation Group and a District Nurse. We spoke with seven patients and with four members of staff.

Patients were able to access a range of appointments. Saturday morning nurse clinics were held. One patient told us "I can't say I have ever wanted an appointment and been in a position where I couldn't get one".

Patients were happy with the service they received. A patient said "I don't think you could get a better practice".

Patients were protected from abuse because the practice had trained staff to be aware of abuse and report any suspicions of abuse taking place. All the patients we spoke with said they felt safe with the GPs and nurses.

The risk of infection had been minimised because current guidance in control of infection and good hygiene were being followed.

Staff received support and training relevant to their role. A member of staff told us "I love it here, it's great. We're well supported by all the doctors".

The views of patients were sought and acted upon. Annual satisfaction surveys were carried out and the practice had an active Patient Participation Group.