Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hugh Wright on 15 October 2015. The overall rating for the practice was requires improvement. The full comprehensive report can be found by selecting the ‘all reports’ link for Dr Hugh Wright on our website at www.cqc.org.uk.

We carried out this announced follow up comprehensive inspection on 4 July 2017. Overall the practice is now 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. .
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Establish effective systems and processes to ensure the practice seeks and acts on feedback from relevant persons on the services provided for the purposes of continually evaluating and improving such services, such as the GP Patient Survey.

The areas where the provider should make improvement are:

• Review risk assessment related to the defibrillator to ensure adequate arrangements are in place to keep patients safe in an emergency.

• Identify and support patients with caring responsibilities so their needs can be met.

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 of Dr Hugh Wright on 15 October 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Arrangements were in place to ensure patients were kept safe. For example, staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses
• Patients’ needs were suitably assessed and care and treatment was delivered in line with current legislation and best practice guidance.
• We saw from our observations and heard from patients that they were treated with dignity and respect and all practice staff were compassionate.
• The practice understood the needs of their patients and was responsive to them. There was evidence of continuity of care and people were able to get urgent appointments on the same day.
• There was a culture of learning and staff felt supported and could give feedback and discuss any concerns or issues with colleagues and management

However, there were also areas of practice where the provider must make improvements:

Action the provider must take to improve:

• The practice should develop a clear vision and strategy to deliver high quality care and promote good outcomes for patients and ensure all staff are aware of it.

• Ensure clinical audits are undertaken in the practice, including completed clinical audit or quality improvement cycles.

• Ensure an up to date environmental risk assessments is carried out and risks are regularly monitored.

• Ensure an up to date infection control audit is undertaken.

Action the provider SHOULD take to improve

• The practice should ensure an automated external defibrillator (used to attempt to restart a person’s heart in an emergency) is available or should carry out a risk assessment to identify what action would be taken in an emergency.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We went back to the practice to review the action plan that had been implemented as there were areas of none compliance from the inspection visit on the 4 July 2013. There were no patients at the practice at the time we visited. We spent time talking to the practice manager, staff and looking at records.

People were involved in making decisions about their care. If they needed to be referred to a specialist this was explained and they were able to express a preference of where they were referred to. People's needs were assessed and their care was planned in a way to ensure their safety and welfare. Where people had had a chronic disease review there was documented evidence to show that a treatment plan had been developed to manage their condition for the coming months.

The emergency drugs were in place and staff were clear about their roles and responsibilities in a medical emergency.

There were systems in place to ensure that staff were able to identify and respond appropriately to abuse for both adults and children.

We spoke with six people who used the service. They felt that their GP spent time listening to their concerns and explaining any treatment needed. One person told us "I feel safe and confident about this practice". We also looked at people's comments on the NHS Choices website. We saw that negative comments had been reviewed by the Patient Participation Group (PPG) who were also involved in developing a feedback questionnaire.

People were involved in making decisions about their care. If they needed to be referred to a specialist this was explained and they were able to express a preference of where they were referred to. People were treated by suitably qualified and skilled staff that received appropriate professional development. Whilst people's needs were assessed their care was not always planned in a way to ensure their safety and welfare. Where people had had a chronic disease review there was a lack of documented evidence to show that a treatment plan had been developed to manage their condition for the coming months. Items were missing from the emergency equipment and staff were unclear about their roles and responsibilities in a medical emergency.

There was a lack systems in place to ensure that staff were able to identify and respond appropriately to abuse for both adults and children. Medical records were securely stored and most were fit for purpose. There were systems in place to monitor the quality of service people received.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hugh Wright on 4 July 2017. The overall rating for the practice was Good, however the practice was rated as requires improvement in relation to providing ‘caring’ services. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Dr Hugh Wright on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 22 August 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 4 July 2017. 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.

Our key findings were as follows:

• The practice had appropriate equipment in place to support patients in an emergency.
• The practice had addressed patients areas of concern which was now reflected in the improved GP patients survey results.
• The practice had implemented process to improve the identification of patients with caring responsibilities so their needs can be met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice