Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Street Surgery on 3 November 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had organised annual health road shows for two consecutive years. These were held in the local Town Hall providing easy access. Multiple charities were invited to provide stalls offering information and advice to patients and clinicians alike. The PPG attended these running a refreshment stall with the aim to raise funds for patient improvement at the practice. In 2016 the practice held a small flu clinic during the road show to further encourage flu vaccine uptake. This was supported by the attendance of nursing and reception staff.

The areas where the provider should make improvement are:

• Ensure patients waiting for their appointments in all areas of the practice can be clearly seen by reception staff to ensure patients whose health might deteriorate can be seen by staff.
• Ensure the process for security of dispensary keys is reviewed and monitored.
• Improve the recording of references for new members of staff and ensure that staff are risk assessed prior to undertaking chaperone duties.
• Continue to develop methods used to proactively identify carers.
• Ensure that the learning from complaints and significant events is shared and disseminated with the appropriate staff within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we last visited the practice on 27 November 2013 and 2 December 2013 we found that improvements were required. The practice wrote to tell us about the action they planned to take. This inspection visit took place to check that the improvements had been completed.

We found the practice had implemented regular checks of the emergency equipment so that patients could be assured they would receive treatment from staff who used equipment that was safe and ready for use.

Improvements had been made to the safe storage of medicines in the dispensary and to monitor safe temperatures for refrigerated medicines.

All staff had access to appropriate support and training and training had been planned,reviewed or completed.

The practice had reviewed systems for monitoring comments and complaints to ensure that any issues raised were responded to appropriately and in a timely manner.

During the inspection we became concerned that recruitment procedures were not being followed and asked to see some recruitment records. We reviewed five staff files and found that appropriate checks were not always completed before staff began work to ensure they were suitably skilled and experienced to provide safe and appropriate care.

Patients that we spoke with were very complementary about the service they received. They told us that the reception staff were friendly and helpful and they received good support and advice from the doctors and nurses. During our observations we saw that patient privacy and confidentiality of information was maintained.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Some items of emergency equipment had not been checked to ensure they were ready and safe to use.

Dispensary staff followed clear systems for obtaining, handling and dispensing of medicines. Most medicines were kept safely although improvements were required to the security of controlled drugs and medicines that were refrigerated.

Staff told us they felt supported by the doctors and practice manager although they felt communication could be improved. Most staff received an appraisal and had access to training. However, the policy for mandatory training was unclear, training records were poor and staff did not always have appropriate levels of knowledge in issues such as safeguarding or what action to take if they had concerns about poor practice.

There was information available to patients advising them on how to raise a complaint. Although there was a complaints process in place this was not followed by staff so that complaints were managed effectively.