This practice is rated as Good overall.

(Previous rating April 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Boneyhay Surgery on 12 March 2019 as part of our inspection programme, to follow up on breaches of regulations.

At our last inspection in April 2018, we found that the provider was in breach of regulations 12 and 17. The regulations were not being met as the registered person had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment. In particular:

Regulation 12:

• Health and safety risk assessments were not completed as required.
• Risk assessments of the safety and security of the premises had not been completed.
• COSHH risk assessments had not been completed.
• Non-clinical staff who acted as chaperones had not received appropriate training to support them in the role.
• Effective systems were not in place for the appropriate monitoring of all high-risk medicines prescribed.

Regulation 17:

The registered person had systems or processes in place that operated ineffectively in that they failed to enable the registered person to assess, monitor and improve the quality and safety of the services being provided. In particular:

There was a lack of management oversight of governance arrangements related to:

• Recruitment processes
• Staff lead roles and responsibilities
• Staff training.

At this inspection we found:

• That the practice had made significant improvements in most areas. However, they remained in breach of regulation 12 as: effective systems were not in place for the appropriate monitoring of all high-risk medicines prescribed.

• 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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure effective systems are in place for the appropriate monitoring of all high-risk medicines prescribed.

The areas where the provider should make improvements are:

Complete the policies they have under review.

Take action to improve staff files and records.

Improve the recall process for patients with long-term conditions.

Take action to ensure furniture in clinical rooms is suitable for the intended purpose.

Take action to include the ongoing complaints process in response letters.

Review the requirement for nurse appointments when the nurse has days off.

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 at Boneyhay Surgery on 25 April 2018. This inspection was carried out as part of our inspection programme.

At this inspection we found:

• When incidents happened, the practice learned from them and improved their processes.
• The practice had systems to keep patients safe and safeguarded from the risk of abuse.
• Staff recruitment practices were not in line with legal requirements.
• Systems had not been implemented to ensure that health and safety risk assessments were completed.
• Effective systems were not in place to monitor training completed by staff and some staff had not received mandatory training.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines. However, it had not routinely reviewed the effectiveness and appropriateness of the care it provided.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There were some gaps in the practice’s governance arrangements.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

For details, please refer to the requirement notices at the end of this report.

The areas where the provider should make improvements are:

• Improve the arrangements for ensuring that the facilities and equipment are safe and in good working order.
• Implement clearly identified systems for the ongoing monitoring of staff training.
• Review the arrangements for access to health and safety risk assessments and maintenance work completed by external contractors.
• Review the systems in place to manage significant events provides details of all events identified.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice