Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr JH Clarke and Partners on 15 December 2015. 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. However, recruitment records for locum GPs did not include a check of photographic identification although staff told us this was because they were previously known to the practice.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients we spoke said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However the national GP patient survey results indicated the practice was performing below average in involving patients in their care and decisions.
• Information about services and how to complain was available and easy to understand.
• Patients said they sometimes found it difficult to make an appointment with a named GP although those we spoke with told us they felt that there was continuity of care, with urgent appointments available the same day.
• The practice had a robust system for obtaining consent for invasive procedures, however their system for obtaining consent for the use of medical photography included recording verbal consent but not a record of written consent.
• 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. However, minutes of meetings did not always include a clear record of attendance and actions to be taken.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice had achieved a children and young people’s service Pacesetter award through the local CCG for their work in designing appropriate services for young people. In addition the practice worked closely with other services to host appropriate services on site at the practice. This had included dermatology clinics, a DVT service and a wound care service where patients would otherwise have had to travel 40 miles to hospital. In addition the practice regularly reviewed care plans with ambulance services to facilitate care in the patient’s home and avoid hospital admission.

The areas where the provider should make improvement are:

• Ensure that recruitment records for locum GPs are of the same standard as those of permanent staff.

• Ensure written consent is obtained for the use of medical photography.

• Ensure that the results of the national GP patient survey are discussed and used to make improvements, for example in relation the GP consultations.

• Continue to address issues around patient access to appointments.

• Ensure minutes of meetings include a clear record of attendance and actions. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Dr JH Clarke and partners is rated as good overall. (Previous inspection 15 December 2015 rated as good overall).

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) - Outstanding

We carried out an announced comprehensive inspection at Dr JH Clarke and partners on 8 March 2018. The inspection was carried out as part of our inspection programme.

Following this inspection, we received information of concern that led us to carry out an unannounced inspection on 29 March 2018. Concerns raised included the lack of medication reviews and care plan reviews for older patients, issues with safety in areas of the practice environment, security of prescription paper, restrictions on recording and reporting significant events and a lack of reception cover. The review of these concerns is incorporated into the findings in this report.

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.
• Patient records we saw were clear, accurate and contained comprehensive information about the care and treatment of patients.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had appropriate and safe facilities and was well equipped to treat patients and meet their needs. The practice had plans for significant redevelopment to improve facilities further.
• Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and phone consultation services were available.
• Recruitment procedures kept patients safe. This included recruitment records for temporary staff.
• Staff had been provided with appropriate training, supported to develop new skills and received an up to date appraisal. Induction systems were comprehensive and tailored to each staff member.
• Staff were positive about working in the practice, their training and support and the openness of senior staff.

We saw one area of outstanding practice:

The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had achieved two service pacesetter awards; one children and young people's service Pacesetter award through the local Clinical Commissioning Group (CCG) for their work in designing appropriate services for young people noted at our last inspection in 2015 and a second awarded in 2018 for work to develop ‘mental health friendly’ services. The latter was in collaboration with a neighbouring CGG and coastal West Sussex MIND, a mental health charity.

The area where the provider should make improvements are

Continue to keep the toilet facilities and potential issues with the old lift pit under review until such time as they are resolved by the redevelopment programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice