At our previous comprehensive inspection at Cressex Health Centre in Buckinghamshire on 26 April 2017 we found a breach of regulations relating to the premises, specifically the premises at the branch practice. Although the overall rating for the practice was good, the practice was rated requires improvement for the provision of safe services. The practice was rated good for the provision of effective, caring, responsive and well-led services. In addition, all population groups were also rated good.

The full comprehensive report on the April 2017 inspection can be found by selecting the ‘all reports’ link for Cressex Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in April 2017. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 10 April 2018 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. The overall rating remains good.

Our key findings were as follows:

• Systems had been implemented and embedded which ensured care and treatment was provided in safe premises.

• Until the full refurbishment was completed, the practice had continued to assess, manage and monitor the environmental risks at the branch practice. The refurbishment was completed in March 2018 and all the previous risks to patient safety had been minimised through defined and embedded systems.

• There was an improved system to effectively monitor and improve patient outcomes for patients on the learning disabilities register. For example, there were two designated leads who managed the learning disability register, an administrative lead and a clinical lead. We saw all the patients on the learning disability register had been contacted and invited to attend or have a home visit for a learning disability health check. We saw the improved system and invites and in some cases a series of invites had significantly increased the uptake rate.

• The practice had continued to review the existing arrangements with regards to the number of patients completing the bowel cancer screening programme, with a view to increase uptake rates. For example, the practice had worked with the national bowel cancer screening programme team and consented to the practice name being added to the bowel cancer screening kits. Evidence based research has shown that endorsement by a patient’s own GP practice on invitation letters leads to an increase in screening uptake.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Cressex Health Centre in High Wycombe, Buckinghamshire on 18 August 2016. The practice was found to be inadequate in safe and requires improvement in effective, caring, responsive and well led. The overall rating for the practice was requires improvement. Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected no longer than six months after the report is published. The full comprehensive report on the August 2016 inspection (published in October 2016) can be found by selecting the ‘all reports’ link for Cressex Health Centre on our website at www.cqc.org.uk.

The main issues of concern found at the August 2016 inspection related to a lack of formal governance arrangements including systems for assessing, monitoring and mitigating risks at the branch practice. We also found concerns within safeguarding, medicines management, training and patient satisfaction.

We carried out an announced comprehensive inspection at Cressex Health Centre on 26 April 2017. Overall the practice is rated as good. The improvements which led to these ratings apply to all population groups which are now rated as good.

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

• The practice had demonstrated significant improvements in governance arrangements and reflected strong and visible clinical and managerial leadership.

• Although environmental risks still remain at the branch practice; these risks had been assessed, managed and monitored.

• We found that completed clinical audit cycles were driving positive outcomes for patients.

• Data showed the practice had demonstrated improvements in patient’s outcomes.

• Staff feedback had been considered and the practice had increased staffing levels.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, the practice had consulted with staff and patients to improve the appointment system including opening times.

• Patients reported improved access to the clinical team. The practice had increased the availability of appointments to patients, enabling them to book appointments in advance with the GPs. The practice had also implemented processes whereby patients could speak to GPs on the telephone and/or attend early morning appointments held each weekday.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider must make improvements is:

• Ensure the suitability of the branch practice for which they are being used and properly maintained.

The areas where the provider should make improvements are:

• Improve the systems in place to effectively monitor and improve patient outcomes for patients on the learning disabilities register.

• Review the systems in place to promote the benefits of bowel screening in order to increase patient uptake.

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 Cressex Health Centre on 18 August 2016. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be inadequate for safe service. It was require improvement for provision of effective, caring, responsive and well led services. The concerns which led to these ratings apply to all population groups using the practice.

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

• We noted the current provider had inherited number of challenges when they took over the practice in July 2015. We saw the practice had developed comprehensive action plans, implemented changes and shown improvements in number of areas. However, they were required to make further improvements.
• There were inconsistent arrangements in how risks were assessed and managed. For example during the inspection we found risks relating to management of legionella, medicines management, safeguarding adults and children training and management of blank prescription forms for use in printers which had not been monitored appropriately.
• Monitoring of fire safety, infection control procedures, record keeping, management of health and safety issues at the branch practice and Disclosure and Barring Service (DBS) checks for non-clinical staff undertaking clinical duties were not always managed appropriately.
• Patients said they were not satisfied with the appointment booking system; they had to wait a long time to get through to the practice by phone and found it difficult to make an appointment with a named GP.
• We found that completed clinical audits were driving positive outcomes for patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. However, some staff had not received annual appraisals and undertaken training relevant to their role.
• Data from the national GP patient survey and national screening programme showed patient outcomes were low compared to others in locality and the national average.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Information about services and how to complain were available and easy to understand. However, information about a translation service was not displayed in the reception areas and there were limited information posters and leaflets available in other languages.
• There was a clear leadership structure and staff felt supported by management. The practice 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:

• Further review, assess and monitor the governance arrangements in place to ensure the delivery of safe and effective services. For example, medicines management, the management of blank prescription forms and improve record keeping of medicine, fridge temperature and cleaning checks.
• Ensure effective monitoring of health and safety of the premises such as fire safety, management of legionella and infection control.
• Ensure effective monitoring of health and safety of the branch surgery premises and ensure it is suitable for the purpose for which they are being used and properly maintained.
• Ensure to carry out a Disclosure and Barring Scheme (DBS) check or a risk assessment for non-clinical staff undertaking chaperoning duties to ensure risks are managed appropriately.
• Ensure all staff receive an annual appraisal and undertake training relevant to their role including safeguarding children and adults, fire safety, basic life support, health and safety, infection control, mental capacity, and equality and diversity.
• Consider patient feedback about the appointment system. Review the appointments booking system and the waiting time it takes to get through to the practice by telephone. Improve the availability of non-urgent appointments with a named GP.
• Review and improve the systems in place to effectively monitor and improve patient outcomes for patients on the learning disabilities register, patients experiencing poor mental health, and promote the benefits of cervical, breast and bowel screening to increase patient uptake. Review and improve the national GP patient survey results.

The areas where the provider should make improvements are:

• Review the system in place to further improve the patient outcomes for patients with asthma and rheumatoid arthritis (inflammation and pain in the joints).
• Ensure information about a translation service is displayed in the reception area informing patients this service is available. Ensure information posters and leaflets are available in multi-languages.
• Consider staff feedback, and continue to review and improve the staffing levels to ensure the smooth running of the practice and keep patients safe.
• Consider installing a hearing induction loop at reception and improve access at the branch practice (Lynton House).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice