We carried out an announced comprehensive inspection at Collingham Medical Centre (previously known as Dr Lisa Terrill & Partners) on 15 November 2016. The overall rating for the practice was good, with a rating of requires improvement for the responsive section of the report. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Collingham Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 5 February 2018 to confirm that the practice had addressed the areas for improvement that we identified in our previous inspection on 15 November 2016. This report covers our findings in relation to those improvements made since our last inspection.

Our key findings were as follows:

At our previous inspection on 15 November 2016, we rated the practice as requires improvement for providing responsive services because patients sometimes experienced difficulties in accessing appointments. At this inspection we found that the arrangements in respect of access to appointments had significantly improved. Consequently, the practice is now rated as good for providing responsive services.

• National GP patient survey data showed patients’ satisfaction with how they could access care and treatment had increased since our previous inspection and was comparable to local and national averages. This was supported by patients spoken with during this inspection.

• The practice had introduced new staff roles to enable them to make better use of clinical resources and direct patients to the most appropriate response.

• A programme of regular auditing was used to oversee appointment availability and to identify areas for improvement.

At our previous inspection we identified two other areas where we had asked the provider to make improvements:

• Review the processes in place for recalling patients for blood monitoring when high risk medicines are being prescribed.

• Work with patients to develop a new patient participation group (PPG).

At this inspection we found that improvements had been made in both these areas.

The recall arrangements for patients prescribed high risk medicines had been strengthened. There was a clear protocol in place, which included a register of patients requiring this type of monitoring, and we found this was being implemented reliably. If patients failed to attend for their blood tests the practice made repeated attempts to contact and encourage them to do so. Clinicians were kept informed about patients whose tests were overdue so they could consider risk and discuss with the patient if they attended the practice for other reasons. The practice had carried out an audit to help drive improvement in this area. A second audit had also been completed in January 2018 and showed that improvements had been achieved.

The practice had established a new PPG in October 2017. There was a formal structure for this group, including terms of reference and regular, minuted meetings. During this inspection we reviewed documents relating to the PPG and met members of the group. The PPG had identified communication between patients and the practice as a key area for improvement and were supporting the production and sharing of written information for display and distribution. This included a newsletter, updating the practice website, reception area notice boards and circulating information throughout the local area, to help make it more easily accessible to patients. During January 2018, the PPG had promoted the completion of Friends and Family feedback cards, resulting in 88 completed responses, which was a significant increase in comparison to previous months. These responses were to be reviewed at the next PPG meeting and an action plan prepared to take forward the findings from this.

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 Dr Lisa Terill & Partners on 28 July 2015. The overall rating for the practice was good with a rating of requires improvement in responsive. The full comprehensive report published on the 8 October 2015 can be found by selecting the ‘all reports’ link for Dr Lisa Terill & Partners on our website at www.cqc.org.uk.

This inspection was undertaken to follow up the areas requiring improvement and was an announced comprehensive inspection on 15 November 2016. Overall the practice is rated as good.

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

• There were effective systems and processes in place which enabled staff to report and record incidents and significant events. Learning from significant events was identified and shared appropriately.
• Risks to patients were assessed and managed across the practice.
• Staff had the skills, knowledge and experience to support them to deliver effective care. Staff were supported to access to training to increase knowledge and keep up to date.
• Care and treatment was delivered in line with evidence based guidance.
• The majority of patients felt they were treated with compassions, dignity and respect and were given the opportunity to be involved in decisions about their care.
• The practice’s complaint policy reflected national guidance and legislation. Information about how to make a complaint was accessible to patients in the practice and on the website.
• Patients could generally access urgent appointments when these were required although there could be a long wait for routine appointments. A range of appointments were offered including telephone appointments. The practice had recently set up an acute care same day service to reduce waiting times.
• The practice had good facilities and was well equipped to treat patients and meet their needs. A range of services were hosted in house to enable patients to access services closer to home including an audiology service and an osteopathy service.
• There was a clear leadership structure in place within the practice and staff felt supported by the partners and the management.
• Feedback was sought from patients and staff and action was taken as a result. The practice was in the process of forming a new patient participation group.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review the processes in place for recalling patients for blood monitoring where high risk medicines are being prescribed
• Work with patients to develop a new patient participation group
• Continue to review and improve access to routine GP appointments

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 Dr Terrill & Partners (Collingham Medical Practice) on 28 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and well-led services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students) and people whose circumstances may make them vulnerable.

It required improvement for providing responsive services and care for people experiencing poor mental health.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Urgent appointments were usually available on the day they were requested. However, patients said they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through the practice when phoning to make an appointment.
• Information about how to complain was not easily available for people who used the service.
• 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, with improvements required to storage of clinical waste.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and most staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

The practice coordinated the provision of a volunteer led transport service with the patient participation group (PPG). The service is for patients registered with the practice who struggle to access public transport within the village. A team of volunteer drivers used their own cars to support patients to attend a range of health related appointments and social activities. At the time of our inspection there were 18 drivers, 250 registered patients and 256 trips had been undertaken to hospitals and the GP practice.

This feature was outstanding in that service provision went beyond the normal scope of clinical practice and the practice used additional resources available to them to ensure patients within the rural community were supported to access health services and community activities.

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

Importantly the provider must:

• Ensure the regular review of phone access, processes for making appointments and availability of non-urgent appointments; as part of assessing, monitoring and improving the quality and safety of services.
• Ensure information and guidance about how to complain is available and accessible to everyone who uses the service. Additionally, effective systems must be in place to ensure that all complaints are investigated without delay and verbal complaints are fully recorded.

In addition the provider should:

• Ensure completed clinical audit cycles are undertaken and used to drive improvements.
• Ensure infection prevention and control processes are reviewed and strengthened, specifically the storage of non-clinical waste.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice