We previously carried out an announced comprehensive inspection at Dr AD Pullan & Partners on 22 November 2017. The overall rating for the practice was good. The practice was rated requires improvement in providing a responsive service. The full comprehensive report on the 22 November 2017 inspection can be found by selecting the ‘all reports’ link for Dr AD Pullan & Partners on our website at

This inspection was an announced comprehensive inspection carried out on 12 November 2018 as part of our inspection programme and to confirm that the provider had made improvements in providing responsive services.

This practice is rated as Good overall.

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

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.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found access to appointments problematic but reported that they were able to access care urgent when they needed it. The practice had implemented a number of measures to address access to appointments, the impact of which had yet to be reflected in the National GP survey results.

The areas where the provider should make improvements include:

• Audit and revaluate the impact of the changes implemented to improve patient access to the service.
• Review and reconcile the list held of patients on the practice safeguarding registers with external agencies to ensure they are current.
• Consider fully documenting the root cause analysis conducted for significant events and complaint investigations.
• Improve communication with care home managers.
• Improve the detail in the practice final response to complaint letters to include information on the ‘next steps’ patients may choose to take.
• Improve staff awareness of the Accessible Information Standard.
• Consider keeping copies of the practice business continuity plan off site.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. We previously inspected the service on 25 November 2014 and rated the service Good overall.

The key questions 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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at AD Pullan & Partners on 22 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems, processes and practices in place to protect people from potential abuse. Staff were aware of how to raise a safeguarding concern and had access to internal leads and contacts for external safeguarding agencies.
• The practice had 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 but did not share learning practice wide or carry out a regular analysis of incidents to identify common trends.
• There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.

• The partners had reviewed and increased its workforce and employed additional clinicians to help meet the health needs of patients and the demand for access to appointments.
• Staff had received essential training to enable them to carry out their duties safely.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient satisfaction with their experience of contacting the practice and making appointments continued to be below local and national averages. Feedback we received on the day of the inspection and in completed CQC comments cards, showed this was starting to improve following the implementation of a new telephone system and more staff available to answer telephone calls during peak periods. However, a small number of patients told us they still encountered problems with accessing appointments which was also reflected in reviews left on NHS Choices website. The practice was actively continuing to monitor the situation.
• The practice worked proactively with the local community and patient participation group (PPG) to meet the needs of their patients and the local population.
• There was a focus on learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review the process for recording, sharing and learning from significant events and carry out a regular analysis to identify common trends and themes.
• Review the storage and security of oxygen cylinders held at the practice.
• Consider reviewing and reorganising staff recruitment files so they are clearly organised and contain all of the required information.
• Ensure policies and procedures that govern activity are clearly accessible, dated, reviewed to reflect practice and shared.
• Review the monitoring of uncollected prescriptions.
• Take a more proactive approach to identifying carers.
• Strengthen the management of complaints.
• Continue to review and improve patient access to the service.

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 Dr AD Pullan and Partners on 25 November 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive services and for being well-led. The practice was found to be good for the services it provided to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.
• GPs worked with patients and their families and carers to ensure that they understood how treatments could support their health and that they received the most appropriate care for their needs.
• Patients told us that the staff were caring, compassionate and respectful towards them. Information showed that GPs and nursing staff were good at listening to patients.
• The practice proactively sought feedback from patients and staff. Access to services and changes to the environment and the way it delivered services were made as a result of feedback received by the practice.
• The practice had a clear vision and values which were shared with its patients and staff. Staff felt supported by the leadership in place.

There were some areas of practice where the provider needs to make improvements.

In particular the provider should:

• Ensure that systems in place clearly demonstrate an audit trail of how lessons learned and plans for improvement from significant events/incidents, and near misses are disseminated to staff.
• Ensure that meetings are minuted to clearly show what was discussed, action to be taken, by whom and when.
• Ensure that staff are aware of the process they should follow if safeguarding concerns are identified.
• Ensure that blank prescriptions are stored securely at all times
• Ensure that risk assessments are completed on all staff considered to not need criminal records checks via the Disclosure and Barring Service
• Ensure that confidential patient information is not being inadvertently insecurely stored in the cluttered consulting room.
• Consider providing an alarm call in the disabled toilet.

• Consider providing baby changing facilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with eight patients and six members of staff. Prior to our inspection we spoke with a spokesperson from the patient participation group (PPG) who was also a patient. A PPG is an effective way for patients and GP practices to work together to improve services and improve quality of care. One patient told us, “I have nothing to complain about at all. The doctors are very good”. Another patient told us, “Dr X listens to me and gives me all the time I need. I have the highest degree of confidence in Dr X”.

We saw that patient’s views and experiences were taken into account in the way the service was provided and that patients were treated with dignity and respect. We saw that patients experienced care, treatment and support that met their needs.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to ensure that patients were protected from harm. The provider did not have systems in place to ensure patients were cared for by suitably qualified professional staff. We saw no evidence in staff files that checks to ensure staff were registered with their appropriate professional bodies had been carried out and were in date.

The provider had an effective system to regularly assess and monitor the quality of the service that patients received.