Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A.S. Cook & Partners on 5 January 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were assessed and well managed.

• 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.

• Feedback from patients about their care was consistently and strongly positive.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment with a named GP and that 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.

• 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 several areas of outstanding practice:

• The practice had a clear vision to deliver high quality care and promote good outcomes for patients. This was documented as a covenant, based on a commitment to the whole of a patient’s life. We saw evidence of this in how the practice responded to individual needs, such as how older people were cared for.

• The practice had developed a proactive anticipatory care plan for patients which provided a framework for the patient, their family, carers and health care professionals to work together to plan care. The care plan was used in care homes and the practice was able to provide evidence of a significant reduction in hospital admissions from care homes. The care plan had been adopted by the CCG for use by other practices.

• GPs provided out of hours support for end of life care seven days a week, reducing unnecessary hospital admissions and helping patients achieve a dignified death in the place of their choosing. The practice also provided 24 hour on call cover seven days a week to a children’s hospice.

• The practice was proactive in providing equipment for patients for improved diagnosis and self care. For example, they provided cardiac memos and had 22 blood pressure monitors for patients to borrow to aid diagnosis and support self care. This enabled patients to get faster access to the treatment they needed.

• The practice had set up a patient library with books covering a wide range of topics including mental health issues which patients were encouraged to borrow. Patients had fedback that this facility was very helpful and gave them access to information they wouldn’t otherwise have had.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This was a follow up inspection to check the provider had taken the required actions to meet essential standards following our previous inspection in April 2014.

During this inspection we spoke with the practice manager and the lead nurse responsible for infection control within the practice.

We found the provider had taken steps to ensure that people were protected from the risk of infection. People were cared for in a clean, hygienic environment.

This was a follow up visit to check that the provider had taken the required actions to meet essential standards following our previous inspection in October 2013.

During our inspection we spoke with 4 members of staff, including GPs, nurses and the practice manager. We also collected 17 responses to a survey questionnaire we left in the patient waiting area.

People commented that they were happy with the service they received. One patient commented “This is a very pleasant surgery with a nice atmosphere.” Another patient commented “This is a very good, professional and friendly practice. The quality of care received at this practice was a factor in a recent decision not to move away from the area.”

We found that people were protected from abuse through the provision of suitable training given to staff, the presence of clear policies and the ready availability of information to staff and people who used the service.

Since our last inspection, the provider had taken some steps to ensure that people were protected from the risk of infection. People who commented told us that the standard of cleanliness was good, very good or excellent. One person commented “The environment is clean, well looked after and comfortable.” However, we found that that the provider did not have adequate arrangements in place to protect patients and staff against the risk of infection and cross contamination and procedures were not always followed to ensure a safe and clean environment.

The provider had taken steps to improve their recruitment processes and to ensure that patients were cared for and supported by suitably qualified, skilled and experienced staff. Staff files had been updated since our last inspection visit and a revised recruitment policy had been developed.

We saw that the consultation rooms were private. This protected patient’s privacy and dignity. We noted that the doors of the rooms were closed during consultations and that people inside could not be overheard. People told us that the consultations were carried out in an appropriate manner, protecting their privacy and dignity.

We observed that staff treated patients in a respectful manner. Staff were polite, patient and caring in their approach.

Patient’s told us that they were happy with the service they received. One patient told us, "It is an excellent service. There is a good friendly environment and everyone really seems to pull together as a team."

We saw that there was no clearly defined process for staff to follow in cases where abuse might be suspected, nor information about the types and signs of abuse to look out for. We saw that the service undertook safeguarding training in relation to children but no training had been undertaken by staff in safeguarding vulnerable adults.

The provider was not able to demonstrate that they had suitable arrangements in place to reduce the risks of exposure to legionella. Employers, or a person in control of the premises, are responsible for health and safety and need to take the right precautions to reduce the risks of exposure to legionella.

We saw that staff had been recruited without robust reference checks. We saw that only one out of the eight personnel records we examined had contained a written reference that had been obtained.