We carried out an announced focused inspection at Cross Plain Health Centre on 11 June 2018 in response to concerns that were reported to us. We did not rate the practice as part of this inspection.

At this inspection we found:

• The practice had a long-term plan to develop the role of Physician Assistants (PA) within the practice and an interim strategy to develop the role and competence of non-qualified staff to enable them to take on duties previously done by qualified and registered clinicians. However, this was not supported by evidence found on inspection.
• The practice vision was in line with national strategies and priorities. They had engaged with other external stakeholders and received financial support for the development work from Wiltshire Clinical Commissioning Group (CCG).
• We found the practice had employed staff in a number of different roles who they called GP Assistants. It was not clear to patients what these different roles were or the competency of staff performing these roles.
• We looked at the clinical work of a number of staff working in the role of GP Assistant and found evidence they were working within their areas of skills and experience, and there had been some appropriate oversight and support from a GP.
• We saw evidence the practice monitored the work done by staff in the role of a GP Assistant.
• The practice governance arrangements for the employment, training, supervision and monitoring of staff working in the role a GP Assistant lacked clarity.

The areas where the provider must make improvements are:

• The practice must ensure staff employed receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

• The practice must assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity (including the quality of the experience of service users in receiving those services).

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 Salisbury Plain Health Partnership on 8 December 2016. Overall the practice was rated as requires improvement. We found the practice to be requires improvement for providing safe and effective services, and good for providing caring, responsive and well led services. The full comprehensive report on the 8 December 2016 inspection can be found by selecting the ‘all reports’ link for Salisbury Plain Health Partnership on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection on 8 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe and effective services. Overall the practice is now rated as good. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

• The practice had reviewed their standard operating procedures with regard to controlled drugs and had ensured those medicines were checked regularly.

• The temperature of the medicines fridge in the dispensary was checked regularly.

• The practice had reviewed their process for the exception reporting of patients with long term conditions and had ensured patients who had previously been excepted, had received the appropriate reviews. (Exception reporting is the removal of patients from Quality Outcome Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• The practice had reviewed its systems to ensure patients who had not collected their medicines from the dispensary were contacted in a timely manner.

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 Salisbury Health Partnership, also known as, Cross Plain Surgery, on 8 December 2016. Overall the practice is rated as requires improvement.

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 for reporting and recording significant events. Incidents and significant events were discussed at a range of meetings including weekly clinical meetings and monthly team meetings.
• Although risks to patients were assessed and well managed, systems and processes to manage risks in the dispensary were not applied consistently.
• 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. The practice had a positive ethos for the continuous development of staff.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice worked with Wiltshire County Council in hosting well-being courses for patients with mental health problems, obesity and substance and alcohol misuse problems.

• 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.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

• The practice recognised the need of its local population and took part in various initiatives to improve outcomes for patients. They developedled an initiative called “Serving on UK” where practice staff who had knowledge of the armed forces supported veterans and families of serving military personnel to have better access to NHS services. The practice had worked with the South West Armed Forces Network, NHS England, the local clinical commissioning group and local military charities so that this initiative could be rolled out nationally.

• The practice had set up a specific Mental Health team which included two mental health support workers employed by the practice under the leadership of a lead GP who had specific qualification and experience in mental health and substance misuse issues. This enabled patients to be reviewed and have increased access to support when they needed it.

The areas where the provider must make improvement are:

• Ensure controlled drugs are checked in accordance with their standard operating procedures.

• Ensure the temperature of the medicines fridge in the dispensary is checked daily.

• Ensure the number of patients with long term conditions who had been excluded from reviews are appropriately reviewed and identify ways to improve uptake for these reviews.

The areas where the provider should make improvement are:

• Ensure uncollected medicines are acted upon in a timely way.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

On 11 June 2018 we carried out an announced focused inspection at Cross Plain Health Centre in response to concerns that were reported to us. We found there were breaches in the regulations relating to staffing and good governance. We carried out a second announced focused inspection at Cross Plain Health Centre on 11 September 2018, to follow up on the issues identified on our previous inspection of 11 June 2018. The full report on these, inspections can be found by selecting the ‘all reports’ link for Cross Plain Health Centre on our website at www.cqc.org.uk.

This report covers the announced comprehensive inspection we carried out at Cross Plain Health Centre on 23 and 24 January 2019, as part of our inspection programme, to review the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements in relation to staffing.

At this inspection we found:

• The practice had adopted an innovative use of staff in the role of GP Assistants. The use of staff in this role in GP practices was still in development in England and we saw evidence the practice was engage with the national development of staff working these roles.
• We found that staff working in the role of GP Assistant were working within their areas of competency. The clinical notes we saw evidenced safe and supportive care that had been appropriately reviewed by a suitably qualified clinician. These findings are in line with what we found on our previous inspections in June and September 2018.
• The practice had made significant changes to their processes and systems relating to staffing and good governance since our inspection in June 2018 and were now meeting the regulatory requirements. However, there were a few areas where the changes had not been fully embedded.
• Staff treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

We saw one area of outstanding practice:

• The practice had their own mental health support team that were able to offer same day appointments and provided a special access service for patients registered with other practices in Wiltshire, who were at risk of being excluded due to their behaviour. We saw evidence the service was in the process of being adopted by other GP practice in the locality and training on the service was being prepared both for other GP practices in Wiltshire and local Ministry of Defence primary care services.

The areas where the provider should make improvements are:

• Take appropriate action to ensure all staff have appropriate references on file.
• Review their standard operating procedure for dispensing medicines and ensure it is in line with their actual practice and best practice guidance.
• Continue to embed changes of staff titles into the practice culture and procedures.
• Review how they record complaints and significant events to ensure learning points are clearly identified and they are able to spot trends and patterns that might relate to staff working in the new roles the practice had developed.
• Continue to make all appropriate efforts to establish an active patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice