Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection report published 3 September 2015 - Good)

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

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 Dr Bouch and Partners on 6 December 2017 as part of our regulatory functions.

At this inspection we found:

• The practice had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes.
• Effective monitoring processes were in place, which included for example, health and safety, recruitment, training and appraisals. The practice had three non clinical staff who had not attended the recent basic life support refresher training and two staff who had been off sick when their appraisal was scheduled. However the practice were aware of this and had scheduled these to be completed.
• 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. Support and monitoring was in place for the clinical pharmacist and nursing staff, and the monitoring of the work undertaken by the nurse practitioners was formalised and effective.
• Staff treated people with compassion, kindness, dignity and respect and involved them in decisions about their care and treatment. All staff had received equality and diversity training. The practice patient information leaflet was available in large print and audio format.
• Patients found the appointment system easy to use and reported that access to appointments was positive; this was supported by a review of the appointment system and data from the National GP Patient Survey. The practice were aware of patient feedback in relation to the length of waits once patients had arrived for their appointment. This had been discussed with all the GPs and informal and formal feedback mechanisms were agreed.
• The practice had responded to the needs of patients and suggestions from staff. We saw a number of examples of this including health checks for patients with a learning disability being undertaken in their own home, raising the height of the patient toilet and changing the days practice meetings took place.
• Information on the complaints process was available for patients at the practice and on the practice’s website. There was an effective process for responding to, investigating and learning from complaints.
• Staff had the skills, knowledge and experience to carry out their roles and there was a strong focus on continuous learning and improvement at all levels of the organisation. Staff we spoke with felt supported by the practice.

The areas where the provider should make improvements are:

• Ensure the non-clinical staff members complete the planned basic life support refresher training.
• Monitor the exception rates for the quality and outcomes framework data, with the aim to reduce this over time.

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 Bouch and Partners on 28 July 2015. 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. It was also good for providing services for all the population groups.

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, reviewed and addressed.

• The practice was safe for both patients and staff. Robust procedures helped to identify risks and where improvements could be made.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The GPs, nurses and healthcare team at the practice had knowledge and skills which enabled the practice to offer a wide range of services to patients. It employed advanced nurse practitioners who were able to see a broader range of patients than the practice nurse and had led to an increase in the number of appointments available to patients.

• Information about services and how to complain was available and easy to understand and patients’ complaints were responded to empathetically.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• Staff had received training appropriate to their roles and any further training needs had been identified and planned.

We saw several areas of outstanding practice including:

• There was a strong learning culture and the practice was committed to primary care development and education. It took an active part in GP education and primary care research and encouraged staff at all levels to develop their knowledge and skills.

• The practice had developed an audit programme which was both comprehensive and embedded. The practice had completed an extensive scheme of clinical audit cycles, covering a broad range of areas. There was evidence that this had led to improvements in outcomes for patients. We saw that the results of audits had been shared routinely across clinical teams.

• The practice proactively engaged with local voluntary groups. The Citizen’s Advice Bureau (CAB) attended the practice every month, and the practice hosted carers’ support days every three months with good attendance rates by patients. Local community groups such as Age UK, and patient advice and liaison services regularly gave talks at the staff meetings to raise their awareness of services that could be accessed by patients.

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

Importantly the provider should

• Have a system in place to monitor the non-collection of prescriptions.

• Ensure that chaperone services are better advertised to patients.

• Hold review meetings about vulnerable patients with safeguarding concerns with other health and social care professionals

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with eight clinical staff, five non clinical staff and twelve patients which included three members of the patient participation group. We also spoke with representatives from two care homes where patients were registered at the surgery and with family members of four of those patients. We also spoke with one health care professional and one social care professional who worked with the surgery.

We found that guidance regarding consent was available to staff and the clinicians we spoke with had a good understanding of this. This was confirmed by the patients and their representatives who we spoke with.

There was a system in place for the recall of patients with long term conditions. We saw evidence that this was provided to patients registered at the surgery and those who lived in care homes. The surgery had recently set up a more robust method of ensuring patients who did not respond to recall requests or who did not attend their appointment were contacted by the GP.

We saw that the surgery worked in partnership with other services, to review and plan care for patients identified as being at end of life and those who had unplanned admissions to hospital.

We found that guidance regarding safeguarding was available to staff and the staff we spoke with had a good understanding of this.

Staff at the surgery felt well supported and received training appropriate to their role. Appraisals had been undertaken and staff were supported to meet their objectives.

There was an effective process in place for acknowledging, investigating and responding to complaints.