Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Central Surgery on 15 July 2015. Overall, the practice is rated as good.

Specifically we found the practice to be good for providing safe, effective, caring, responsive and well-led services. The practice was good for providing services for older people, people with long term conditions, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health.

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

• The practice held a fortnightly vasectomy clinic. The waiting time for this was three to four weeks compared with eight to ten weeks in secondary care. The practice also accepted referrals from other practices for the vasectomy clinic.

• 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

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff received training appropriate to their roles and further training needs were identified and planned.

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

• Information about services and how to complain was available and easy to understand.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients and acted on this.

We saw an area of outstanding practice:

The practice ran an eye clinic three to four days per week. Having the eye clinic meant that most eye emergency cases for Central Surgery patients were managed entirely by the primary care ophthalmologist. In addition to this the practice accepted referrals from other practices.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

Review the consent protocol to ensure they are satisfied they adequately document consent for all procedures

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We spoke with six patients. One patient told us, ''People have great confidence in the surgery.’’ Another patient identified that, ''There are sufficient staff, appointment waiting times are not too bad and access is not too bad.’’

We spoke with 11 staff, including two GP partners and four community professionals who had worked in collaboration with the surgery. The community teams we spoke with identified that practice staff and GP partners had worked with them to meet patients’ needs.

We found that good communication and referral pathways existed between the surgery and other healthcare professionals. Patients told us that their GP had supported them throughout the referral process. We saw that patients had been involved in making decisions about their care and treatment and forums existed to encourage patients to air their views.

Systems and guidance were in place to protect vulnerable adults and children. Staff knew who to approach and what to do should a safeguarding event take place.

We saw systems in place to assess and monitor complaints at the surgery.

We carried out an announced comprehensive inspection at Central Surgery on 14 March 2019 as part of our inspection programme. We previously inspected the practice on 15 July 2015 when we rated the practice as good in all areas with an overall 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 good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. They had engaged with the clinical commissioning group and adopted local safeguarding procedures and staff were all trained and aware of how to deal with safeguarding issues.
• The practice monitored their performance in the Quality and Outcomes Framework (QOF) and addressed areas which required focus. 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.
• The practice was well organised with structured working patterns to provide access for patients and meet their needs. However, patients’ satisfaction with accessing the practice by telephone was below the local and national averages.
• The practice had doctors with clinical expertise in specific areas which was used effectively to deliver services, such as family planning, hormone replacement therapy and minor surgery.

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

• Review the system to ensure it captures all significant events and that the learning is shared with relevant staff.
• Review the training programme to establish a more streamlined approach to the practice’s mandatory training.
• Ensure the updates on National Institute for Health and Care Excellence (NICE) guidance are included in clinical meetings.
• Review the system for identifying and supporting carers to ensure their needs are met.
• Introduce a system to formalise clinical oversight of prescribing nurses.
• Continue to monitor telephone access to ensure changes are effective.
• Monitor the system for recording prescriptions within the practice.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care