Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bradford & Partners on 6 December 2016. The overall rating for the practice was good, but the practice was rated as requires improvement for effectiveness. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Bradford & Partners on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 27 November 2017 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 in 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good for all key questions.

Our key findings were as follows:

• The practice had developed stronger processes to review notifications and to ensure that when these indicated that medicines needed to be changed, patients were recalled, rather than waiting for an opportunity to make changes when the patient visited the practice or requested a prescription.
• The practice improved the follow up of patients who did not attend for cervical screening.

The practice had also, in response to our recommendations:

• Formalised how training was monitored to ensure staff completed updates.
• Acted on below average feedback on nursing care in the 2015/16 national GP patient survey. We suggested in the last report that the plan to address this be formalised. The 2016/17 national GP Patient survey showed substantial improvement in nursing feedback, with all results now in line with national average.
• Completed an audit, designed by the practice, into monitoring of patients on a medicine for high blood pressure.
• Employed a Data Quality Lead to improve templates and call/recall processes.
• Changed the appointment booking system to allow patients to book extended hours appointments in advance.
• Decided to purchase a hearing loop.
• Improved the template complaint response letter to include details of organisations that patients can contact if they are unhappy with the practice’s handling of their complaint, and updated the complaints policy and the practice website.
• Drafted terms of reference for the patient participation group (PPG), which had been presented at the June 2017 PPG meeting and were due to be discussed in detail in December 2017.

The provider should:

• Continue to review accessibility for patients who have a disability.
• Continue to monitor and act on cervical screening test uptake.

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 Bradford and Partners on 6 December 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. However, the practice did not have effective recall systems to respond to alerts.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The number of female patients aged between 25-64 who had attended the practice for a cervical smear was below the national average.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.

The areas where the provider must make improvements are:

• The practice must ensure that patients are recalled where notifications suggest that medications must change rather than waiting to make these changes opportunistically.

• The practice must ensure that there is an effective system for recalling female patients aged 25-64 for a cervical smear test.

The areas where the provider should make improvement are:.

• Consider formalising how staff training was monitored to ensure that all staff are up to date.

• Consider formalising templates used in annual reviews so that all relevant information is recorded.

• Consider developing practice instigated audits outside of those requested by the CCG.

• Consider formalising the practice’s response to poor feedback about the practice nursing staff.

• Consider offering appointments for extended hours appointments in advance.

• Consider reviewing accessibility for patients who have a disability.

• Consider adding the health service ombudsman’s details to letters replying to complaints.

• Consider drafting terms of reference for the patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice