Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chapeltown Family Surgery on 5 May 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.
• 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 identified low uptake of bowel cancer screening due to cultural beliefs and had appointed a bowel cancer champion to increase this. The bowel cancer champion used various methods to engage with patients including involvement of a local radio station. GPs and reception staff linked with the local community and Clinical Commissioning Groups and the practice had appeared in the local press and handed out leaflets at a local place of worship. The practice had also taken part in a citywide bowel screening programme, this involved appearing in a Youtube video which was broadcast in a large shopping centre. As a result of work undertaken by the practice, bowel cancer screening uptake had increased from 33% to 52%, this represented a 50% increase.

The areas where the provider should make improvement are:

• Should implement systems to audit checks on emergency drugs to avoid expiry dates being overlooked.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Our inspection on the 14th January 2014 we found the provider did not have robust systems in place to reduce the risk and spread of health care associated infections. Following the inspection the provider wrote to us and told us they would take action to ensure they were compliant with these essential standards.

We spoke to five patients who had appointments at the practice, three members of the reception/administration staff, the practice manager and two of the doctors at the practice.

The patients we spoke with were satisfied with the practice and the care they received. They told us they felt involved in their care and the staff were, “Brilliant” and had “Been really good, really helpful.” Two of the patients we spoke with had recently registered with the practice They had been given information about the practice and asked to complete a patient questionnaire. They had found the staff courteous and “Very good.”

Patient’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that was intended to ensure patient's safety and welfare.

The systems to reduce the risk and spread of infection were unsatisfactory. The practice had not had regard to The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance and staff and patients were not adequately protected from the risks of infection.

Staff received appropriate professional development. Staff felt well supported and were encouraged to raise any concerns with the practice manager or clinical staff. Staff were able to obtain further relevant qualifications.

The practice had an annual audit programme to monitor and asses the standard of care and the service patients received. Patient and staff were asked for their views about their care and treatment. The practice had established a Patient Participation Group which had assisted the practice to improve the appointments system.