Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beeches Green Surgery on 24 November 2016. The overall rating for the practice was requires improvement because breaches of regulation relating to the safe and well led provision of services were identified. The full comprehensive report on the 24 November 2016 inspection can be found by selecting the ‘all reports’ link for Beeches Green Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 June 2017 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 on 24 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had ensured that identified risks relating to infection control and fire safety had been actioned and managed.
• All recommended training had been undertaken by staff.
• Policies had been reviewed and updated relating to chaperone duties.
• Learning from significant events were being shared to drive improvement in a timely manner.
• The practice had focussed on improved collaborative working with the patient participation group.

The area where the provider should improve:

• Review systems and processes to encourage carers to attend for an annual health check.

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 Beeches Green Surgery on 24 November 2016. Overall the practice is rated as requires improvement.

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

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations were discussed. However lessons learnt were not shared in a timely way to support improvement and action points that had been documented were not always completed.
• There were practice specific policies that were available to all staff. However these had recently been implemented and we did not see evidence that these were embedded within the practice, for example the chaperone policy.
• There were arrangements for identifying, recording and managing risks, issues and implementing mitigating actions. However these were not always fully implemented, for example, in relation to infection control and fire safety.
• Not all staff had received essential training, for example, infection control and the appropriate level of children’s safeguarding.
• The practice had a virtual patient participation group (PPG) but recognised that the relationship between the practice and the PPG could be more effective and told us that this was a focus for them going forward.
• The practice provided cognitive behaviour therapy (CBT- a talking therapy that can help manage problems by changing the way people think and behave) for their patients.
• The practice provided an audiology service for their patients with good outcomes for patients.
• The practice provided medical services and psychiatric support to two residential units for people with eating disorders.

We saw two areas of outstanding practice:

• The practice supported patients with mental health problems. This included medical services to two residential units for people with eating disorders. It was recognised that this cohort of patients were high users of medical services. The practice provided general medical care, wound care in instances of self-harm and psychiatric support when necessary. The practice also provided cognitive behaviour therapy (CBT- a talking therapy that can help manage problems by changing the way people think and behave) for their patients.
• The practice provided an audiology service for their patients. We saw evidence that this had significantly reduced the number of referrals to secondary care, and had in the last six months identified six potentially serious cases that were referred for further care in a timely way. Patients were appreciative of the service which provided prompt care close to home.

The areas where the provider must make improvements are:

• Ensure risks in relation to infection control and fire safety are monitored and managed
• Ensure identified actions identified in risk assessments are completed.

• Ensure recommended training has been undertaken.

In addition the provider should:

• Review and update policies in relation to chaperone duties
• Review procedures for reviewing significant events to ensure learning is shared to drive improvement in a timely manner.
• Continue the focus on improving collaborative working with the patient participation group.
• Improve the process for inviting carers for health reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice