Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jackson and Partners on 10 May 2016. The overall rating for the practice was requires improvement. We undertook a further announced focused inspection on 24 January 2017. The overall rating for the practice remained at requires improvement. The full comprehensive reports on the May 2016 and January 2017 inspections can be found by selecting the ‘all reports’ link for Dr Jackson and Partners on our website at www.cqc.org.uk.

This inspection was an announced comprehensive carried out on 16 November 2017 to check whether the provider was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This practice is rated as Good overall. (Previous inspections May 2016 and January 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

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

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 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

Consideration should be given to whether specific complaints need to be recorded as significant events.

Review the systems in place for reviewing changes introduced overtime for significant events and complaints to assess whether the changes have been effective and embedded into practice.

Consider the arrangements in place to support non--clinical staff to be aware of patients at risk of sepsis.

Review the process for regular monitoring of prescriptions that have not been collected.

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 Jackson and Partners (previously known as Dr Walters and Partners and also known as Mayford House Surgery) on 24 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the 10 May 2016 inspection can be found by selecting the link below on our website at www.cqc.org.uk. http://www.cqc.org.uk/location/1-577985237

This inspection was an announced focused inspection carried out on 24 January 2017. The inspection was 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 at our previous inspection on 10 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as requires improvement.

Our key findings were as follows:

• The system and processes in place for reporting, recording and reviewing significant events had improved in some but not all areas. Despite this we identified that significant events were still not always being recorded and actioned and in some cases there was insufficient information recorded to allow adequate investigation.

• There were still gaps in the safeguarding children and adults training completed by staff.

• The practice had addressed some of the issues relating to medicines management.

• All staff had a Disclosure and Barring Service (DBS) check in place. Despite this there remained some concern in respect of the management of the recruitment process.

• The practice had made some improvement in the management of health and safety. We saw evidence to show that recommendations by external agencies had been acted on. However, there remained gaps in staff training in this area. For example fire safety, health and safety and cardio pulmonary resuscitation (CPR).

• The practice had in the last two weeks put a system in place to ensure patients with a learning disability were recalled to the practice for a review.

• The practice could not demonstrate how they ensured role-specific training and updating for relevant staff. Whilst some recent steps had been taken by the practice management to review the systems for managing training there remained significant gaps in the completion of mandatory training. There was a lack of understanding as to the frequency of the requirements of such training.

• Since our last inspection there had been significant changes in the partnership arrangements. There was a new partnership arrangement and a new CQC registered manager in place. There was a clear commitment from the new partnership to deliver improvements.

• Evidence showed the partners had started to take steps towards improving the governance arrangements at the practice. Whilst there was clear evidence of improvement there were still areas that required improvement or further improvement.

Importantly, the provider must:

• Ensure that all significant events are reported, reviewed, investigated and that measures are in place to see whether the changes introduced have been effective and embedded into practice.

• Ensure that all vaccines are stored, managed and disposed of properly so that immunisations are carried out safely and efficiently in line with Public Health England guidance.

• Review the effectiveness of the management of training so that persons employed by the practice receive appropriate training as is necessary to enable them to carry out the duties they are employed to perform.

• Review the effectiveness of the governance systems and processes in place to enable the practice to assess, monitor and mitigate risks to the health, safety and welfare of their patients and staff.

At our previous inspection on 10 May 2016, we rated the practice as inadequate for providing safe services and requiring improvement for providing effective and well led services. Whilst improvement had been made at this inspection and there was evidence of an improvement pathway we still found issues that required improvement or further improvement. Consequently, the practice has been rated as requires improvement for safe which is reflective of some of the improvement we saw; requires improvement for effective as little improvement had been made in respect of training, and well led rated as requires improvement. It should be noted that there has been improvement in this area with the new partnership arrangement and some of the new governance arrangements and engagement with staff. However there are still a wide range of areas that need improvement. Consequently the rating for well led remains as requires improvement.

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 Walters and Partners (Mayford House Surgery) on 10 May 2016. Overall the practice is rated as requires improvement.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when things went wrong reviews and investigations were not thorough enough and lessons learned were not communicated widely enough to demonstrate improvement.
• The practice had some processes and practices in place to keep patients safe and safeguarded from abuse. We identified areas of risk from lack of processes or adherence to processes. For example, not all the nursing team had a Disclosure and Barring Service (DBS) check. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable. Not all staff (clinical and non-clinical) had completed training or could demonstrate they had completed training in safeguarding adults and children.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example reports from external advisors relating to fire safety and legionella had not been fully actioned.
• The arrangements for managing medicines in the practice did not always ensure patients were safe.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about how to complain was available and easy to understand. Whilst complaints were responded to and the patient offered an apology, the documentation lacked detail as to how complaints had been investigated. Lessons learnt and action taken was not sufficiently detailed to assure actions had been implemented and lessons had been learnt.
• Patients said they found it easy to make an appointment. Routine and urgent appointments were available the same day but not always with a GP of choice.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had some governance arrangements but they did not always operate effectively. Risks and issues were not always identified and dealt with appropriately or in a timely way. There was a lack of oversight and monitoring in some key areas.
• The approach to service delivery and improvement was reactive in most instances and focused on short term issues. Improvements were not always identified or actioned. Where changes were made the impact was not always monitored.

The areas where the provider must make improve are;

• The provider must ensure that incidents that may affect the health, safety and welfare of people using services are always reported. They must be able to demonstrate that such incidents, whether a significant event or a complaint are recorded, reviewed and thoroughly investigated to prevent further occurrences.

• Where risks are identified, ensure measures are put in place to reduce or remove the risks within a timescale that reflects the level of risk and impact on people using the service.
• The provider must ensure the proper and safe management of medicines.
• The provider must ensure a system of clinical audit is in place to allow the practice to demonstrate sustainability of improvement in patient care over a period of time.
• The practice must ensure that the systems in place to recall patients with a learning disability is appropriate to meet the needs of these people to ensure an improved uptake of patient annual reviews.

• Staff must receive appropriate, training as is necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improve are;

• The practice should ensure recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff.

• The practice should ensure that staff who act as a chaperone have had a DBS check.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice