We carried out an announced comprehensive inspection at Blue Dykes Surgery on 4 April 2019 as part of our inspection programme.

At the last inspection in June 2018 we rated the practice as requires improvement for providing safe and well-led services because:

• Some systems and clinical oversight needed strengthening
• Quality assurances of some clinical work and management of incoming patient correspondence was not satisfactory.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of good quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Review the system for monitoring and tracking blank prescriptions through the practice is effective.
• Review the process for recording fire drills within the practice.
• Continue to review and monitor patient satisfaction of appointment availability.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as ‘requires improvement’ overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Blue Dykes Surgery on 11 May 2018. This inspection was undertaken following Chesterfield Royal Hospital NHS Foundation Trust’s registration as the new provider for Blue Dykes Surgery with the Care Quality Commission (CQC) on 5 September 2017. The inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had systems to report untoward events and near misses. When incidents did happen, the practice learned from them and improved their processes.
• 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.
• The practice had developed a clinical skill mix model which helped patients get to see the right professional the first time. The practice’s clinical team included GPs, pharmacists, advanced nurse practitioners, practice nurses, and a community psychiatric nurse (mental health nurse). The practice also employed a chronic disease nurse who saw housebound and care home patients.
• Royal Primary Care had a clear strategy and had developed visions and values which had been communicated with the practice team to ensure individuals understood their contribution to this.
• The recent appointment of a Clinical Divisional Director and General Manager for Royal Primary Care provided designated clinical leadership and management with links to the wider Trust.
• Staff treated patients with compassion, kindness, dignity and respect.
• Patients did not always find the appointment system easy to use and reported that they sometimes had difficulty in accessing care when they needed it. Managers had acknowledged this and had developed an action plan to make improvements.
• Staff appraisals were undertaken annually and staff were encouraged and supported to develop their skills and enhance their role.
• Staff told us that it was a good place to work and that they felt valued and supported. They said that managers were visible and approachable.
• Managers and clinical leads worked with their Clinical Commissioning Group (CCG) to consider forward planning to meet the needs of their patients. Managers had considered future succession planning arrangements for the practice.
• Staff had the skills, knowledge and experience to carry out their roles effectively and the practice was able to evidence this by means of an up to date training matrix.
• The inspection identified some patient safety concerns in relation to infection control, the safe monitoring of vaccine refrigerator temperatures, and an adequate failsafe procedure for the cervical cytology programme.
• We found that greater oversight was necessary in reviewing the performance of the extended clinical team. For example, there was limited evidence of consultation audits to provide assurance on this matter. The quality assurance of tasks such as the management of incoming correspondence also required strengthening.

We saw the following area of outstanding practice:

• The practice had developed an extensive programme of clinical and non-clinical audit. We saw numerous examples of audits undertaken over the last 18 months, many of which were part of an ongoing audit cycle. Eight second cycle audits had been completed within the last six months, and a further six had been completed as part of the continuous audit cycle programme. We saw how these had impacted on positive outcomes for patients, for example: ensuring that actions were completed in response to safety alerts; compliance with standards of best practice and prescribing guidelines; safe monitoring of patients prescribed high risk medicines; and to review concerns raised via the incident reporting or complaints system.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.

The areas where the provider should make improvements are:

• The practice should ensure that the uptake of annual reviews for patients with a learning disability is improved.
• Continue to review access to appointments to improve patient experience.
• Royal Primary Care should retain copies of documents to provide evidence of their compliance with our regulations at practice level. This includes building maintenance records, site reports and risk assessments. Whilst this information could be sourced through their contractor, the practice should be able to produce this directly to demonstrate compliance.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice