Letter from the Chief Inspector of General Practice

The Culverhay Surgery in Wotton-Under-Edge was inspected on the 9 December 2014. This was a comprehensive inspection.

The Culverhay Surgery in Wotton-Under-Edge Gloucestershire, GL12 7LS provides primary medical services to people living in the town of Wotton-Under-Edge and the surrounding villages. The practice also has two branch surgeries. One in Wickwar, held in the Community Centre, Avon Crescent on Monday afternoons from 12 noon, and a second in Hawkesbury Upton at the Bethesda Chapel, Park Street on Wednesdays from 12:30pm. We did not visit these branches as part of our inspection.

At the time of our inspection there were approximately 6,300 patients registered at the Culverhay Surgery. This is a dispensing practice and provides a dispensing service to approximately 40% of the practice population. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting which is a set distance from a pharmacy.

Patients using the practice also have access to community staff including district nurses, health visitors, and midwives.

The practice has opted out of providing out of hours services to their own patients and refers them at evenings and weekends, when the practice is closed, an Out of Hours service delivered by another provider.

We rated this practice as Good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from incidents were taken advantage of.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• 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.

• Patients had a variety of ways to make appointments and found the practice to be flexible in meeting their needs. We were told patients could always get an appointment.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Patients told us the practice was clean and safe.

• The practice had a clear vision which had quality and safety as its first priority and high standards were promoted and owned by all practice staff with evidence of team working across all roles.

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

Action the provider SHOULD take to improve:

• All clinical staff should receive training in the Mental Capacity Act (2005). The MCA is a legal framework which supports patients who needs assistance to make important decisions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating April 2018 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced comprehensive inspection at Culverhay Surgery on 10 April 2018. Overall the practice was rated as good for providing effective, caring, responsive and well-led services as well as overall. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report of the 10 April 2018 inspection can be found by selecting the ‘all reports’ link for Culverhay Surgery on our website at .

This inspection was an announced focused inspection carried out on 14 August 2018. The purpose was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 10 April 2018. 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 services. Overall the practice remains rated as good.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Acute prescriptions for Controlled Drugs were signed by a GP before being dispensed to patients.
• There were systems and processes in place to ensure actions were taken when medicine fridges showed signs they had operated outside of the recommended safe temperature range.
• Systems in place had been reviewed and improved to ensure emergency medicines were in date.
• The practice had formalised processes in the dispensary so that medicines checks, including those for controlled drugs and near misses were recorded.
• There were arrangements in place to ensure only authorised staff had access to the dispensary.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice