Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at College Road Surgery on 13 January 2016. The overall rating for the practice was requires improvement, with requires improvement ratings for:

• Providing effective services;

• Providing caring services;

• Providing responsive services;

• Being well-led.

We found the practice required improvement in these areas due to breaches in regulations relating to safe care and treatment, and to providing person-centred care. This was because:

• The practice was not monitoring and screening patients for atrial fibrillation in line with the National Institute for health and Care Excellence (NICE) guidance. The practice had particularly high exception reporting in this area.

• The practice did not make appropriate arrangements to identify patients who are carers to enable them to receive care, treatment and support that meets their needs.

We also found other areas where the practice should improve. These findings were as follows:

• Medicine prescriptions were not always signed for on receipt.

• Respondents to the national patient survey indicated that their satisfaction level in relation to access to care and treatment was lower than local and national averages.

The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Colle Road Surgery on our website at www.cqc.org.uk.

On 27 June 2017 we carried out an announced, follow-up comprehensive inspection to confirm 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 13 January 2016. This report covers our findings in relation to those requirements.

Our key findings were as follows:

• People were protected by a strong, comprehensive safety system and a focus on openness, transparency and learning when things went wrong.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Arrangements for managing medicines kept patients safe. Blank prescription forms and pads were securely stored and there were systems to monitor their use, including processes to ensure they were signed for on receipt.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Most patient outcomes were in line with or above local and national averages.

• The practice was monitoring and screening patients for atrial fibrillation in line with the National Institute for health and Care Excellence (NICE) guidance.

• The practice had appropriate arrangements to identify patients who are carers to enable them to receive care, treatment and support that meets their needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Patients’ satisfaction with how they could access care and treatment was in line with or above local and national averages.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints, concerns and patient feedback.

• There was effective oversight, planning and responses to practice performance.

• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

  The practice is now rated as good for providing effective services, for providing caring services, for providing responsive services, and for being well-led. The overall rating for the practice is now good.

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 College Road Surgery on 13 January 2016. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• 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. We saw evidence where significant events and complaints were discussed and saw examples of changing practice in response to these. Risks to patients were assessed and well managed on the whole but improvements were required especially in light of the high exception reporting for patients with certain long-term conditions.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice carried out audits and made significant improvements as a result.

• The practice had good facilities and was reasonably well equipped to treat patients and meet their needs. However, we did find that the practice did not have an ECG machine.

• There was a clear leadership structure and staff felt supported by the partners and the practice manager.

• Patients described staff as compassionate, caring and approachable.

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

The provider must:

• Make arrangements to identify patients who are carers to enable them to receive care, treatment and support that meets their needs.

• Review exception reporting and ensure that patients with long-term conditions such as atrial fibrillation (irregular heart rhythm) are monitored and screened appropriately following current guidelines.

The provider should:

• Implement a system to ensure the safe management of prescribing stationery across the practice.

• Review the risks associated with not having an ECG machine.

• Keep arrangements to enhance access under review in order to improve patient satisfaction levels.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at College Road surgery on 27 June 2017. The overall rating for the practice was Good. The full comprehensive report on the 21 July 2017 inspection can be found by selecting the ‘all reports’ link for College Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced Comprehensive inspection carried out on 15 March 2018. This report covers our findings in relation to this inspection.

This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable - Requires Improvement

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

At this inspection we found:

• There were areas where systems for identifying and managing risks had not been established, for example fire risk assessment.
• The systems for monitoring training were present but were not effective. For example, we found that not all clinical staff completed training which the practice identified as mandatory.
• The practice had systems around complaints but these were not always effective and were not used as opportunities for learning.
• We found that exception reporting at the practice was high in a number of areas. (Exception reporting relates to patients on a specific clinical register who can be excluded from individual QOF (Quality and Outcomes Framework) indicators. For example, if a patient is unsuitable for treatment, is newly registered with the practice or is newly diagnosed with a condition.) The practice had recently become aware of this and had established a coding issue in their registers and had begun actions rectify to this.
• National patient GP survey data for the practice was generally good overall. The practice were aware of areas that were highlighted as being lower than others and practice had taken some action to start to address this, for example, the practice had increased hours to improve access for patients.
• The practice accommodated a range of languages other than English appropriate to their population group.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment and ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Develop a plan to improve the uptake of national screening programs such as cervical, breast and bowel screening.
• Continue to improve uptake of childhood immunisations in line with national standards and targets.
• Continue to proactively identify and support carers in line with national standards.
• Develop a plan to respond to issues identified from national GP patient surveys to improve patient satisfaction.
• Review the locum induction pack to ensure it is practice specific.
• Consider further ways to raise patient awareness in relation to access to appointments via the Hub.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice