Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Botley Medical Centre on 23 September 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2015 inspection can be found by selecting the ‘all reports’ link for Botley Medical Centre on our website at www.cqc.org.uk.

Following this we carried out an announced focused follow up inspection at Botley Medical Centre on 12 May 2016 where we found that the practice was requires improvement in one of the ‘Well-led’ domain.

This inspection was a desk-based review carried out on 6 February 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 12 May 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:

• Building and safety issues were monitored using an annual risk assessment which was reviewed every six months
• Installation safety certificates had been renewed before their expiry date
• A new medicine fridge temperature log meant that any concerns regarding fridge temperatures were investigated and dealt with immediately

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Our previous inspection in September 2015 found breaches of regulations relating to the safe and well-led delivery of services. The practice was rated good for providing effective and responsive services. The population groups were rated as requires improvement for the patients registered at the practice.

We carried out an announced focussed follow up inspection at Botley Medical Centre on 12 May 2016 to check the practice was meeting regulations. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 23 September 2015.

During this inspection on 12 May 2016, we found the practice had made some improvements since our last inspection, but further improvements were required. The practice is rated as safe for providing safe services and requires improvement for the being well-led.

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

• The practice had improved engagement and communication across different staff group through the introduction of weekly all-team meetings with break-out times for separate teams, and all staff could add to the agenda. The practice had arranged its first team away day for June 2016.

• The practice now ensured that patient consent for treatment such as minor surgery was appropriately asked for and clearly documented on all patient records.

• The practice had reviewed and followed its chaperone policy to ensure that only DBS checked, risk assessed and trained members of clinical staff and the practice manager undertook chaperone duties.

• All staff had completed Mental Capacity Act 2005 training. The practice had purchased new training software and advised all staff to undertake appropriate training relevant to their role.

The areas where the provider must make improvements are:

• Ensure to review and monitor building safety issues, carry out relevant health and safety assessments, and ensure installation safety certificates are renewed before their expiry date.

• Ensure that any concerns regarding medicine fridge temperatures are dealt with immediately according to cold chain policy.

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 Botley Medical Centre on 23 September 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to staff undertaking chaperone duties.
• Data showed patient outcomes were at or above average for the locality. Audits had been carried out, and were seen to be driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect.
• Information about services and how to complain was available and easy to understand.

• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments.

• Patients’ consent to care and treatment was not always sought in line with legislation and guidance.
• The practice had not proactively sought feedback from staff.

The areas where the provider must make improvements are:

• Improve the engagement and communication with staff in the practice across different staff groups.

In addition the provider should:

• Ensure that the training matrices reflect the requirements of the different roles within the practice and are accurately maintained.
• Ensure consent is appropriately asked for and documented on all patient records.
• Ensure recruitment arrangements include all necessary employment checks for all staff. Where staff perform chaperone duties, the practice must risk assess whether a criminal record check through the Disclosure and Barring Service check is required.
• Ensure that training for the Mental Capacity Act 2005 is included in training at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this visit because at our previous visit on 16 September 2013 we found some issues relating to staff awareness of how to spot and report possible signs of abuse of patients and availability of some records relating to staff and the management of the service. For example, records relating to safety checks of the building and equipment could not be located. We asked the provider to take action to address these issues.

The provider had told us, by sending us an action plan, they they were taking action to carry out the improvements needed. This visit was carried out to check that the provider had fulfilled the actions they told us they would take.

The provider had taken action to train staff to spot and report possible abuse of patients. The staff we spoke with were knowledgeable about the various types of abuse they might encounter during their duties. Staff knew how and where to report concerns regarding possible abuse of patients.

The practice provided us with records relating to staff and management of the service that were in good order. We saw that these records could be located when required.

We met with the practice manager and spoke with three members of staff during our visit. We did not speak with patients because it was not appropriate to do so.

On the day of our visit to Botley Medical Centre we met with the office manager and one of the GP partners. We spoke with seven patients and with four members of practice staff.

Patients told us they were treated with dignity and respect. One patient said "I feel safe with the GP’s and nurses who always treat me with dignity and respect”. We saw patients called personally by GP's and nurses when it was time for their appointment.

Patients were happy with the care and treatment they received. One patient said “I have been with this practice for a long time and the service is excellent”.

Patients were not fully protected from the risk of abuse because staff had not been trained to identify and report signs of abuse and neglect.

Patients were protected from the risk and spread of infection because appropriate guidance had been followed.

Staff felt supported in their roles. A member of staff we spoke with said the GP's were "very kind and helpful. They don't mind you bothering them". Staff received training and support appropriate to their roles.

Patient views were sought and their responses were acted upon. The practice had conducted two satisfaction surveys. When patients commented that car park provision was poor, improvements were made.

Some records required to manage the service safely and effectively were not kept or could not be located promptly.

We carried out an announced comprehensive inspection at Botley Medical Centre on 26 March and 2 April 2019 as part of our inspection programme. We first inspected this practice under our new methodology in September 2015 and it was rated as requires improvement. Two further inspections were undertaken in May 2016 and February 2017 before the practice achieved a rating of Good.

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 requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have appropriate systems in place for the safe management of medicines for use in an emergency.
• The practice did not carry out all necessary pre-recruitment checks to ensure staff employed were fit and proper persons.
• The system used to respond to safety alerts was not operated consistently.

We rated the practice as requires improvement for providing caring services because:

• Patient feedback from the national survey and other sources was below average and the practice did not have a clear plan to address this feedback.

We rated the practice as requires improvement for providing well-led services because:

• The management of records, procedures and policies required for the day-to-day management of the service was disorganised.
• Systems to identify, assess and manage risk were not operated effectively.
• Governance processes in place did not always support the clinical delivery of high quality and sustainable care and treatment.

We found some areas of good practice and rated provision of effective and responsive services as good. For example:

• Appointment systems were flexible and offered a range of appointment options.
• 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.
• There was an audit programme focused on quality improvement.

The areas where the provider must make improvements are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We also found areas of provision of service where the provider had not breached regulations but required improvement. Therefore, the provider should:

• Continue to encourage uptake of cervical screening to achieve the national target of 80%.
• Improve uptake of health checks for patients diagnosed with a learning disability.
• Review performance against national targets for care of patients with long term medical conditions with a view to improve outcomes.
• Develop a strategy to address below average patient feedback about the care received from the practice.

(Please see the specific details on action required at the end of this report).

Details of our findings and the evidence supporting our ratings are set

out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care