We carried out an announced comprehensive inspection at Danbury Medical Centre and its branch Mountbatten House Surgery on 26 September 2017. Overall the practice is rated as requires improvement.

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

• There was a clear leadership structure and staff felt supported by management. The practice ensured that communication across both sites was clear and defined.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the practice did not actively monitor trends in significant events.
• All electrical and clinical equipment was checked and calibrated to ensure it was safe to use and was in good working order. We found some clinical consumable items had passed their expiry date for use. The practice acted on this immediately and removed them.
• The practice dispensed medicines to patients. The arrangements for managing medicines, including emergency medicines and vaccines, in the practice kept patients safe.
• We observed the premises to be tidy and generally clean but noted that there was staining throughout the carpets in the Mountbatten site and on the floor of a storage area at the Danbury site.
• Staff had received training on safeguarding children and vulnerable adults relevant to their role.
• 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.
• We reviewed recruitment procedures undertaken prior to employment and we found that that for two members of staff evidence of satisfactory conduct in previous employments in the form of references was missing but the remainder of staff files we viewed were complete and accurate.
• Results from the national GP patient survey showed patients did not always rate the service highly in comparison with local and national averages. The practice was proactive in attempting to address patient concerns as raised through the survey and had implemented various changes as a result.
• The practice had identified less than 1% of the practice population as carers but did signpost them to relevant services.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. But there was no system in place for lessons learnt from individual concerns and complaints to be shared with other staff or stakeholders.
• Patients we spoke with said they did not always find it easy to make an appointment with a named GP but that there was continuity of care, with urgent appointments available the same day.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvement is:

• Ensure care and treatment is provided in a safe way to patients.

There were several areas where the provider should make improvements:

• Monitor trends in significant events and share learning from complaints and their outcomes.
• Review the recording and coding of medical records to ensure accurate and reflective care and treatment of patients, including patients who are carers.
• Respond appropriately to below average patient satisfaction scores in the national GP Patient Survey.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating September 2017 – Requires Improvement).

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Good

We carried out an announced comprehensive inspection at Danbury Medical Centre on 30 October 2018 and followed up on breaches of regulations found during the previous inspection.

At this inspection we found:

• There was a clear leadership structure and staff felt supported by management. The practice ensured that communication across the practice sites was clear and defined.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• There were 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. Incidents were routinely reviewed and analysed to ensure occurrences were not repeated.
• The practice audited and reviewed the effectiveness and appropriateness of the care it provided. Audits showed this was to ensure care and treatment was provided according to evidence-based guidelines.
• The Danbury location dispensed medicines to patients. The arrangements for managing medicines, including emergency medicines and vaccines kept patients safe.
• We reviewed recruitment procedures undertaken prior to employment and found staff files viewed were complete and accurate.
• Information about services and how to complain was available. Improvements were made to the quality of care from the systems in place to learn from the lessons gained from concerns and complaints. These were shared with staff and stakeholders.
• We observed the two locations we inspected to be tidy and generally clean.
• Patients we spoke with said they did not always find it easy to make an appointment with a named GP however, there was continuity of care, and urgent appointments were available the same day.
• Patient satisfaction in the national GP patient survey was low in several areas. The practice carried out their own survey using questions from the national survey to understand whether changes being made were having a positive effect.
• We were told staff treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Increase existing efforts to identify patients that are carers to ensure they are provided the support needed to maintain their health and caring role.
• Continue to monitor patients with diabetes and hypertension to ensure that appropriate reviews are undertaken and performance in this area is maintained.
• Continue to monitor and improve patient satisfaction as identified in the national GP patient survey published in August 2018.

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

Please refer to the detailed report and the evidence tables for further information.