Letter from the Chief Inspector of General Practice

On 1 June 2016 we carried out a comprehensive inspection at Dr Amanda M Davies and Dr C S Jayakumar also known as Peartree Surgery. Overall the practice was rated as requires improvement. The practice was found to be good in providing safe, caring and responsive services. However, they required improvement in providing effective and well-led services. Issues highlighted at the June 2016 inspection were related to the monitoring of patients with long term conditions and the absence of quality improvement processes such as clinical audits to drive improvement. The full report for the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Amanda M Davies and Dr C S Jayakumar on our website at www.cqc.org.uk.

We carried out a focused inspection of the practice on 31 July 2017 to establish whether the improvements required had been met. We found the practice had made appropriate improvements; overall the practice is rated as good.

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

• The practice had improved their clinical performance in respect of QOF. Published figures from 2015/2016 showed the practice had achieved 85% of their total QOF points. Unverified figures showed the practice had improved to 94% in 2016/2017.
• The practice had improved exception reporting by monitoring their patient lists closely.
• The practice had monitored their patients with long term conditions and improved their outcomes.
• The practice had conducted audits to review patients care and drive improvement.
• Their patients experiencing mental health conditions were reviewed and treated in line with their needs and current guidelines.
• The practice had identified 71 patients as a carer which was 1% of their patient list. Carers were offered a range of services and information relating to addition support groups and they were given regular health checks.
• The practice had reviewed their data from the national GP patient survey and conducted internal patient surveys to monitor patient satisfaction.
• The practice had addressed their staffing issues experienced during the previous inspection in June 2016.
• Staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 1 June 2016 we carried out a comprehensive inspection at Dr Amanda M Davies and Dr C S Jayakumar also known as Peartree Surgery. Overall the practice was rated as requires improvement. The practice was found to be good in providing safe, caring and responsive services. However, they required improvement in providing effective and well-led services. Issues highlighted at the June 2016 inspection were related to the monitoring of patients with long term conditions and the absence of quality improvement processes such as clinical audits to drive improvement. The full report for the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Amanda M Davies and Dr C S Jayakumar on our website at www.cqc.org.uk.

We carried out a focused inspection of the practice on 31 July 2017 to establish whether the improvements required had been met. We found the practice had made appropriate improvements; overall the practice is rated as good.

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

• The practice had improved their clinical performance in respect of QOF. Published figures from 2015/2016 showed the practice had achieved 85% of their total QOF points. Unverified figures showed the practice had improved to 94% in 2016/2017.
• The practice had improved exception reporting by monitoring their patient lists closely.
• The practice had monitored their patients with long term conditions and improved their outcomes.
• The practice had conducted audits to review patients care and drive improvement.
• Their patients experiencing mental health conditions were reviewed and treated in line with their needs and current guidelines.
• The practice had identified 71 patients as a carer which was 1% of their patient list. Carers were offered a range of services and information relating to addition support groups and they were given regular health checks.
• The practice had reviewed their data from the national GP patient survey and conducted internal patient surveys to monitor patient satisfaction.
• The practice had addressed their staffing issues experienced during the previous inspection in June 2016.
• Staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We conducted our inspection to follow up on compliance actions following our last inspection on 31 October 2013 when we found concerns.

These concerns related to the provider not having an effective procedure in place to deal with emergencies. In addition we found concerns about the lack of procedures and guidance for dispensing work. There were not appropriate arrangements in place for the obtaining, recording and disposal of controlled drugs. We also found that the process for learning from significant events was not followed.

During our inspection on 05 March 2014 we found that improvements had been made.

We saw that there was a business continuity plan in place at both surgeries. We spoke with two members of staff, both of whom were able to locate this immediately when we asked to see it.

We found guidance was available for dispensing work and there were appropriate arrangements in place for the obtaining, recording and disposal of controlled drugs. We spoke with one member of dispensing staff who told us, "Things are safer. We have guidance for controlled drugs.”

We found that there was an effective process in place for analysing and learning from significant events.

We visited the main surgery and the branch surgery as part of our inspection.

We saw that people were given appropriate support during their care and treatment. One person told us, “They support me to get up onto the couch.” Another person said, “They explain things to me and they go with what I want to do.”

We saw that the surgery staff worked in collaboration with other professionals to meet the needs of the people who used the surgery.

The surgery had equipment and medicines in order to respond to a medical emergency. They did not have a procedure in place in order to respond to an emergency which would affect the provision of services.

The branch surgery was the main dispensing premises, so this site was also visited on the day of our inspection. We found that for dispensing work, the staff had no guidance to follow which could increase the risks associated with medicines. We found inconsistencies in the accounting of controlled drugs.

We saw that the surgery did take action in response to feedback from people who used the surgery. We saw that a system was in place for analysing and learning from significant events, however this was not followed for all significant events.

We spoke with five people, all of whom said they knew how to complain about the service provided by the surgery. One person told us, “I know the complaints procedure but I have not needed to use it.” We reviewed eight complaints. Each had been investigated and a written response provided to the complainant, with an apology if that was appropriate.