This practice is rated as Good overall. (Previous inspection 23 November 2017- Requires improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

This inspection was an a comprehensive announced inspection carried out on 16 May 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 23 November 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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 was a process in place to help protect vulnerable patients from abuse.
• 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.
• Some patients reported that they experienced difficulty accessing the surgery by telephone to make appointments and that routine pre-bookable appointments were sometimes difficult to get.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• There was a strong and dedicated practice team.

The areas where the provider should make improvements are:

• Review the process of accessing the practice by telephone and continue to assess appointment availability.
• Review access arrangements for patients using wheelchairs by consideration of fitting an audible a signal to alert reception staff that a patient needed assistance is negotiating the entrance.
• Ensure that the private telephone numbers of staff are not visible to members of the public.

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 Amos Ramon-The New Coningsby Surgery on 27 October 2015.

Breaches of Regulation 17 (2)(a) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Good Governance were found.

Overall the practice was rated as ‘Requires Improvement.’ Specifically we found it to be requires improvement in safe and effective key questions and good in the caring, responsive and well-led key questions.

This inspection was an announced focused inspection carried out on 23 November 2017 to check that they had followed their action plan and to confirm they now met their legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 October 2015. This report covers our findings in relation to those requirements and also additional issues that arose during the course of that inspection.

You can read the last comprehensive inspection report from October 2015 by selecting the ‘all reports’ link for Dr Amos Ramon on our website at www.cqc.co.uk

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Overall the practice is now rated as ‘Requires Improvement’

Our key findings were as follows:

• Relevant staff had now completed their required infection prevention and control training.

• Clinical audits had been completed.

• Policies in relation to the safe storage of medicines requiring refrigeration had been implemented.

• Learning from significant events had been cascaded to staff.

• The whistle blowing policy had been updated.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Have systems and processes in place that operate effectively to prevent abuse of patients.

• Care and treatment of patients must be appropriate and meet their needs.

• Ensure that patients diagnosed with long term health conditions are reviewed regularly.

• Ensure there are systems or processes that enable the registered person to assess, monitor and improve the quality and safety of the services being provided.

In addition the provider should:

• Should seek to provide a shared computer drive to enable all staff to access policies, protocols and meeting minutes. A shared drive would ensure consistency and provide assurance that all staff were referring to the latest relevant documents.

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 Amos Ramon-The New Coningsby Surgery on 27 October 2015. Overall the practice is rated as ‘Requires Improvement.’ .

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. There was little evidence that learning from significant events was cascaded to relevant staff.
• We saw no evidence that audit cycles had been completed and therefore were not driving improvement in performance to improve patient outcomes.
• The process for handling medicines, including controlled drugs was generally well managed although staff were unaware of the cold chain policy for those drugs that required refrigeration.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. However not all staff had received training appropriate to their roles .
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs, albeit clinical rooms were being used to maximum capacity.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must ;

• Ensure that learning from significant events is cascaded to relevant staff.

• Ensure that the practice undertakes completed cycles of clinical audit.

• Ensure that staff are brought up to date in their training in infection prevention and control.

• Ensure that effective processes are in place to ensure the safe storage of medicines.

In addition the provider should:

• Add the contact details of external agencies to the practice whistleblowing policy.

• Ensure that patients subject to safeguarding concerns were discussed and appropriately identified on their patient record.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with five people who visited the service during our inspection, seven members of staff and the chairperson of the patient participation group.

People told us the reception staff were polite and respectful. One person said, “The reception staff are lovely, they are very helpful.”

People told us that their appointments with the doctor were long enough to allow them to fully discuss their problems and told us they were included in decisions. One person told us, “Dr X is brilliant; they talk to you as an equal.”

People told us they were happy with the service they received. One person said, “It’s a good surgery, the doctors are good and they staff are good.” They told us they were confident in the doctor's abilities.

We saw the systems in the dispensary ensured medication was safely and appropriately kept and dispensed.

The provider listened and responded to the views of people who used the service.