We carried out an announced comprehensive inspection at Dr Christopher Cole and Partners on 20 December 2018.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 28 November 2017.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

• The practice did not always follow their systems and processes which kept people safe and safeguarded from abuse.
• The practice did not consistently follow actions identified in their fire risk assessment.
• Infection prevention and control processes were not fully embedded.
• The safety and efficacy of medicines requiring refrigeration could not be assured.
• The practice could not demonstrate the prescribing competence of non-medical prescribers. While the practice had made some improvements since our inspection on 28 November 2017, it had not appropriately addressed the requirement notice in relation to ensuring that all staff had received training in line with practice policy.

We rated the practice as

good

for providing effective, caring and responsive services because:

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We rated the practice as

requires improvement

for providing well-led services because:

• The practice did not have clear processes for managing the performance of clinical staff.
• The practice’s arrangements for identifying, managing and mitigating risks were not always embedded
• Policies were not consistently embedded, for example in relation to controlled drugs.
• Not all staff felt that leaders were visible and approachable.
• The practice did not maintain oversight of necessary training for GPs.

The areas where the provider

must

make improvements are:

• Assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to improve uptake of cervical screening.
• Continue efforts to identify patients who are carers.
• Continue to use patient feedback to help drive improvements.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection November 2014 – Good)

The key questions are rated as:

Are services safe? - Good

Are services effective? - Requires Improvement

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 - Requires Improvement

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 Christopher Cole and Partners on 28 November 2017. This inspection was part of our inspection programme. We visited both main site and the branch location.

At this inspection we found:

• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• 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.
• Medicines and Healthcare products Regulatory Agency alerts were said to be acted upon but this was not recorded.
• The practice gave us verbal assurances that they conducted regular reviews of their policies however this was only evidenced if changes were made to the policy. The practice could not evidence when a policy had been reviewed and no changes were made.
• Not all patients with long term conditions had their health and care needs checked on a regular basis.
• Not all staff had received mandatory training in line with practice policy such as for Information Governance and Mental Capacity Act 2005
• There was a focus on continuous learning and improvement at all levels of the organisation.

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

Importantly, the provider must;

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The area the provider should make improvements:

• Review feedback from patients such as information gathered by national bodies including the GP patient survey.
• Improve the system for recording when policies are reviewed but not changed.
• Improve the process for the recording of action taken in response to managing and acting on Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Review the process for patients with long term conditions have a regular review of their health and care needs.
• Have a clear programme of quality improvement such as through audit.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection on 5 November 2014. During our visit we inspected the services provided from Waterside Health Centre, we did not visit the branch surgery at Blackfield Health Centre. The practice provides training for GP registrars and medical students.

Overall the practice provided a good service for patients.

Our key findings were as follows:

• Patients were able to access same day appointments.
• Patients were treated with dignity and respect and involved in their treatment.
• Each patient had a named GP to promote individualised care.
• Infection control processes were robust and minimised the risk of cross infection.
• The practice had a clear vision to deliver high quality care and promote good outcomes for patients. We found details of the vision and practice values were incorporated in the day to day running of the practice.
• The practice had robust systems in place to ensure there were always sufficient staff to provide the service; this included forward planning to cover annual leave requirements.
• Patients benefited from an active approach of the practices’ involvement with a separate organisation of 17 GP practices. For example a new phlebotomy service was due to commence in January 2015.

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

The provider should

• The practice should ensure that all staff have relevant safeguarding training for adults as well as children appropriate to their role.

We carried out a comprehensive inspection on 5 November 2014. During our visit we inspected the services provided from Waterside Health Centre, we did not visit the branch surgery at Blackfield Health Centre. The practice provides training for GP registrars and medical students.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice