This practice is rated as Good overall. (Previous inspection report published 6 March 2017 - Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Burlington Road Surgery on 26 February 2018 as part of our regulatory functions.

At this inspection we found:

• The practice had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes.
• The practice had a comprehensive programme of quality improvement activity and 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 clinical team met regularly to keep updated, share learning and review patients.
• The practice had developed a number of initiatives to improve the service provided to patients. For example, the General Practitioner Personal Assistant team; a dedicated clinical administration team.
• Clinicians worked in the multidisciplinary hub to ensure that patients were effectively triaged, assessed and directed to the most appropriate clinician with the right skill set, who then undertook further assessment and coordination as appropriate. Flexible appointment times were offered throughout the day.
• The practice had a strong focus on the training, development and support of all staff. Opportunities for learning were scheduled on a daily basis through the work undertaken in the multidisciplinary hub and a GP partner was always available for support and advice. Effective processes were in place for reviewing and developing the work of locum GPs, advanced nurse practitioners and nursing staff.
• The practice’s uptake for cervical screening was 61%, which was below the 80% coverage target for the national screening programme. The practice were aware of this and had taken some actions to improve the uptake. They had a dedicated nurse responsible for improving the uptake of cervical screening of women who were vulnerable due to language barriers, fear of the procedure or other social barriers. 2017/2018 unverified data showed the practice had achieved 70% so far.
• Staff involved and treated people with compassion, kindness, dignity and respect. All staff had received equality and diversity training. The practice were aware of the needs of the patient population and had health information packs available in four different languages.
• Patients generally found the appointment system easy to use and reported they were able to access care at the right time, although some patients reported dissatisfaction with the length of time taken to answer the telephone. The practice monitored feedback from the National GP Patient Survey and had implemented actions in response to the feedback.

• The practice were in the process of establishing a patient population group and were continuing work to identify patient representatives from the minority ethnic groups to ensure the views of these patients were obtained. They had decided to wait until the merger with another local practice had been completed so that there would be one patient participation group.

• Information on the complaints process was available for patients at the practice and on the practice’s website. There was an effective process for responding to, investigating and learning from complaints and responses to patients were timely.
• Staff told us they were happy to work at the practice, received training and support for their role and were encouraged to raise concerns and share their views.
• There was strong leadership; staff had lead roles and responsibilities. Effective governance processes were in place for ensuring that systems were safe and responded to the needs of patients and for monitoring performance.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice was a teaching practice for medical students and a training practice for qualified doctors training to become GPs. The practice offered opportunities for A level students who had been unsuccessful in their medical school application, to work as a healthcare assistant for one year. The practice advised that of the seven staff who have undertaken this opportunity, all of them have since gained entry to medical school.

The areas where the provider should make improvements are:

• Establish the patient participation group.
• Monitor and improve the uptake of cervical screening.

We saw one area of outstanding practice:

• The practice had set up a ‘multidisciplinary hub’ in 2015, where clinicians, including advanced nurse practitioners, primary care associates and GPs worked together in the same room, led by a GP partner, to ensure that patients were effectively triaged, assessed and directed to the most appropriate clinician with the right skill set. Further assessment was undertaken and care was coordinated by one clinician as appropriate to the patient’s needs, with GP oversight. This was for high risk patients but the service had flexibility to meet the needs of all patients with urgent and routine needs, depending on the demand. Flexible appointment times were offered throughout the day. Training was provided to the staff working in the hub opportunistically, based on the cases which presented. An audit on the effectiveness of the hub was completed in November 2015, which demonstrated positive outcomes. Patients who were at high risk were not delayed in needing to attend the accident and emergency department, as they had instant access to a GP for assessment and advice. Patients were subsequently followed up by a clinician in the hub. Six hours of GP training time was made available to supervise clinical and non-clinical practice staff in the practice. Primary care associates received training and mentoring in real time without affecting or compromising patient access. Feedback on the first 100 cases that the primary care associate in the hub had managed, had been obtained from patients, carers, clinicians and care home managers in November 2015. This feedback showed 100% satisfaction with the assessment and management by the primary care associate who worked in the hub and 100% satisfaction with the speed of delivery of medicines. A review of home visit requests showed that following triage, 30% of requests did not need a home visit; 60% of those patients came to the practice for their appointment and 40% had a telephone consultation. This enabled resources to be directed at those with urgent needs.

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 Burlington Road Surgery on 22 September 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 and there was continuity of care, with urgent appointments available the same day. However, patients commented that it was often difficult to get through to the practice on the telephone.
• 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.

The area where the provider should make an improvement is:

• Continue to investigate ways to improve telephone access to the practice for patients.
• Ensure patients waiting for their appointments in all areas of the practice can be clearly seen by reception staff to enable closer monitoring in case of change in condition.
• Review the process for cascading Medicines and Healthcare Products Regulatory Agency (MHRA) updates throughout the practice to ensure accountability for MHRA alerts is clear and communicated to all staff.
• Continue to re-establish and develop the patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice