Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Doctors Lane Surgery on 30 June 2016. Overall the practice is rated as good.

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 in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained. They had the skills, knowledge and experience to deliver effective care and treatment.
• 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 and routine appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively 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.

We saw some areas of outstanding practice:

The practice’s care of older people. The practice was working with two other practices as part of a frailty pathway project. The outcome aims of the project included areas such as improved patient satisfaction and quality of life, and improved recognition and diagnosis of frailty. The project was in phase one. Early outcomes from Doctors Lane Surgery demonstrated positive results and that appropriate care and referrals were made to support these patients. For example, of the 87 patients identified for the project, three had been referred to continence, 12 to the falls service, four to the memory clinic, 18 to podiatry, six for hearing aid assessments and 27 to HOT clinic. The function of a HOT clinic is to assess and address patients’ needs rapidly within a multidisciplinary structure with the aim being to link with community teams to ensure appropriate care provision is in place.

The practice offered ‘MyGP' an electronic way for patients to communicate with GPs for routine queries. This was of particular benefit for this rural practice.

The practice offered a range of services as part of the ‘Out of Hospital Basket’ enhanced service aimed at providing care closer to patients home. For example deep vein thrombosis diagnosis and treatment, management of stable prostate cancer patients within the community and routine ring pessary fitting and replacement.

If a patient was receiving end of life care then families/carers were provided with the GPs’ personal numbers. If needed and if possible the GP would attend the patient out of hours.

The areas where the provider should make improvement are:

The practice should ensure recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all newly recruited staff.

The practice should assess their access to emergency medicines.

The practice had established a service for people to pick up their dispensed prescriptions at a different location. The practice should review the arrangements for monitoring how the medicines are collected from this location.

The practice should ensure they complete their planned cycle of clinical re-audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Doctors Lane Surgery, Aldbrough St John, Richmond, North Yorkshire DL11 7TH on 21 February 2019. Our inspection team was led by a CQC inspector and included a GP specialist advisor and a CQC Pharmacist.

Our judgement of the quality of care at this service is based on a combination, of what we found when we inspected, information from our ongoing monitoring of data about services, and information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We concluded that:

• Systems were in place to report, record and disseminate learning from significant events and complaints.
• Staff worked to clear protocols and evidence based clinical guidance to meet patients’ needs.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Quality improvement activity was carried out which resulted in improved outcomes for patients.
• Staff treated patients with courtesy and respect. Feedback from patients confirmed this.
• The leadership, governance and culture of the practice promoted an inclusive supportive environment for staff.

Whilst we found no breaches of regulations, the areas where the provider should make improvements are:

The practice should havea regular documented stock balance for controlled drugs. Prescription stationary was recorded upon receipt into the practice and stored securely. However, the practice should review and improve the process for tracking prescriptions throughout the practice.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice