Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brookfield Surgery on 15 June 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• Significant events had been investigated and action had been taken as a result of the learning from events. However, the recording of significant events did not always clearly demonstrate this.

• Systems were in place to deal with medical emergencies and all staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Feedback from patients about the care and treatment they received from clinicians was very positive.

• Data showed that outcomes for patients at this practice were similar to outcomes for patients locally and nationally.

• Staff felt well supported and they were kept up to date with appropriate training.

• Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• The appointment system was flexible and responsive to patients’ needs. Patients said they found it easy to make an appointment with a named GP and there was good continuity of care.

• The practice had good facilities, including disabled access and it was well equipped to treat patients and meet their needs. However, some patients raised a concern that the practice provided limited parking facilities.

• Information about the services provided and about how to make a complaint was available. Complaints had been investigated and responded to in a timely manner.

• The practice had a clear vision to provide a safe and high quality service.

• There was a clear leadership and staff structure and staff understood their roles and responsibilities.

• The practice provided a range of enhanced services to meet the needs of the local population.

The areas where the provider should make improvements are;

• Clearly demonstrate/document the actions taken following significant events.

• Review the chaperoning procedures to ensure these are in line with best practice.

• Consider a planned programme of full cycle audits and formalise a processes for sharing the outcome of audits and implementing changes to practise.

• Review and update the information provided to patients about making and escalating a complaint.

• Risk assess and plan to mitigate risks associated with the use of the annexe.

• Review staff files to ensure all required proof of identification is held by the provider.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice