We carried out an announced comprehensive inspection at Bungay Medical Practice on 12 February 2018. The surgery was inspected under the previous provider, East Coast Community Healthcare Community Interest Company (ECCH) on 9 May 2017 and rated as requires improvement overall; inadequate for providing safe services, requires improvement for providing well led services and good for providing effective, caring and responsive services. The practice was given requirement notices for regulation 12 (safe care and treatment) and regulation 17 (good governance). This inspection was to inspect whether sufficient changes had been made in response to those regulations. The current provider, Dr Castle and Partners, became the provider with the support of the Clinical Commissioning Group on 1 January 2018.

We have inspected, but not rated some key questions. This is because the service had recently been configured and data available related to the previous provider.

The key questions are rated as:

Are services safe? – good

Are services effective? – not sufficient evidence to rate.

Are services caring? – not sufficient evidence to rate.

Are services responsive? – not sufficient evidence to rate.

Are services well-led? - good

As part of our inspection process, we also look at the quality of care for specific population groups. We have inspected, but not rated population groups, because we did not have sufficient evidence to rate. This was because the service had recently been reconfigured and the historical data related to the previous provider.

Older People – not sufficient evidence to rate.

People with long-term conditions – not sufficient evidence to rate.

Families, children and young people – not sufficient evidence to rate.

Working age people (including those recently retired and students – not sufficient evidence to rate.

People whose circumstances may make them vulnerable – not sufficient evidence to rate.

People experiencing poor mental health (including people with dementia) - not sufficient evidence to rate.

At this inspection we found:

• The practice had some 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. However, not all near misses in the dispensary had been recorded. There was an effective and safe system for the management of safety alerts.

• Overall, arrangements for dispensing medicines at the practice kept patients safe. However checks the gap between the most recent controlled drugs check and the previous one was four months The practice had considered some, but not all, risks related to ordering repeat prescriptions over the phone.

• Arrangements were in place to ensure the dispensary was only accessible to authorised staff, however, the arrangements for access were not always reviewed when members of staff left employment at the practice.

• 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. The new provider was in the process of reviewing these systems and processes to ensure patient outcomes were positive.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The new provider was aware of the low results for the GP Patient Survey and they had already changed the appointments system to improve access and planned to monitor the outcome of this.

• The new provider had completed an assessment of the risks within the practice. Staff reported that they felt confident about the changes made and were positive about the future of the practice. The new provider was in the process of updating and changing policies to be specific to them.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Improve the system for recording controlled drugs checks.

• Improve the system for recording and learning from near misses in the dispensary.

• Fully risk assess ordering repeat prescriptions over the phone.

• Improve the system for the access to the dispensary to ensure it is safe.

• Continue to review and update policies to be specific to the new provider.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bungay Medical Practice on 5 November 2018 as part of our inspection programme. The current provider, Dr Castle and Partners, became the provider with the support of the Clinical Commissioning Group on 1 January 2018. The practice was then inspected in February 2018 and not rated due to there being insufficient evidence to rate all key questions. This was because the service had recently been configured and data available related to the previous provider.

Our inspection team was led by a CQC inspector and included a GP specialist advisor and a second CQC inspector.

Our judgement of the quality of care at this service is based 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.

This means that:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• The provider had a detailed action plan in place to address shortfalls within the practice and had implemented several changes such as an overhaul of the management of repeat prescriptions.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• The practice was fully engaged with reviewing, monitoring and auditing the clinical service they offered and used this information to make changes and drive care.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered. For example, the practice had a community matron who was able to assess recent discharges from hospital, complete home visits and address social issues to reduce admissions to hospital.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
• The practice were continually reviewing documents and protocols to update them. We found some protocols and documents that had not been fully updated to reflect the current provider and a standard operating procedure that did not contain all the relevant information. The provider reported this would be addressed immediately.
• Staff reported they were happy to work in the practice and proud of the changes that had been made.

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

• Continue to review documents and protocols to ensure they are specific to the new provider.
• Review and update the standard operating procedure for ensuring medicines are appropriate for use in dosage systems.
• Review the system for responding to complaints to ensure onward referral details for other agencies are available, for example details for the ombudsmen.

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