Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Green and Partners on the 3 October 2016. The practice was rated as requires improvement for the provision of effective services. 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.
• Data showed patient outcomes were higher than or similar to the national average. A number of audits had been carried out. However, there was no future programme of audit to ensure contiuous improvement.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a number of policies and procedures to govern activity.
• 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. However, GPs had not completed fire and equality and diversity training. Mental capacity act training had not been provided to all staff.
• 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 with a named GP and there was continuity of care, with urgent appointments available the same day. However, a number of patients on the day of inspection including written feedback indicated they had to wait a long time in the practice for their appointment.
• The practice had good facilities and was well equipped to treat patients and meet most of their needs. We noted on the day of inspection that there were some accessibility concerns for patients with disabilities. For example, access to the reception area was through a manual door, there was no hearing loop installed and the reception desk was high with no lower level.
• 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 areas where the provider must make improvements are:

• Ensure training is provided to all staff in relation to fire safety, equality and diversity and the mental capacity act.

In addition the provider should:

• Ensure all patients on the learning disability register are invited and increase the number of patients receiving an annual review.
• Review how improvements can be made to the accessibility of the service for all patients.
• Review and take further action to address patient feedback about long waiting times in the waiting room before their appointment.
• Identify and develop a future programme of clinical audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to Dr Green and partners we met with two GP partners. We also met with the practice manager. We spoke with six patients and with four members of staff.

Patients were involved in making decisions about their care and treatment. One patient told us that when a treatment was suggested by their GP they were asked "what do you think about that? Rather than just you will follow this, it's a discussion".

Patients received treatment that was intended to maintain their welfare. Patients were invited to attend for annual check-ups and reviews. One patient we spoke with told us about their annual review, they said "I get an annual health check. They take my blood pressure, check I am exercising and give me advice about alcohol intake”.

The risk of infection had been reduced because current guidance had been followed.

Staff were supported to undertake training appropriate to their role and responsibilities. Staff received and appreciated feedback on their performance in their job.

The practice actively sought the views of patients. Annual satisfaction surveys were carried out and a patient participation group (PPG) was active. We saw that the practice responded to any patient comments posted on the NHS choices website.

Medical records and other records relevant to managing the service were maintained in good order and held securely.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Green and Partners on 3 October 2016. The practice was rated requires improvement for effective services. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Green and Partners on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 15 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 3 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for providing effective services.

Our key findings were as follows:

• Staff had received training pertinent to their role and responsibilities and the training policy had been updated to reflect suitable intervals for updates and further training. All GPs had received fire safety, equality and diversity and Mental Capacity Act (2005) training.

• All patients on the learning disability register had been offered an annual review.

• The practice had identified a programme of continuous clinical audit to improve services to patients.

In addition to the above we saw evidence of the practice taking action to reduce waiting times for patient appointments. The practice had added administration time to patient appointments so patients received a full 10 minutes and the GP had time to write up the patient record. This had been discussed and reviewed with the patient participation group and had commenced in May 2017. Patients who had multiple concerns or complex medical histories were automatically offered a double appointment to accommodate their enhanced needs. In addition, when a clinic was running over, the GPs would announce the delay to the waiting room over the tannoy. These initiatives had been implemented recently and were too early to measure the impact this was having on patient waiting times.

The practice had also reviewed the doorway access from the lobby and waiting room to the reception area. They had applied for funding to reconfigure the ground floor of the building to improve access for patients. The funding was secured in March 2017 and the practice was consulting with an architect, practice staff and the patient participation group to gain views on how this can be improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice