Letter from the Chief Inspector of General Practice

This practice is rated as Requires improvement overall.

(Previous inspection September 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Requires improvement

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students - Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Dr Paul Moss on 20 March 2018 as part of our inspection programme.

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 investigated appropriately and discussed them within meetings however, there was a lack of evidence on what actions were taken to reduce the risk of reoccurrence.
• Prescription stationery was not stored securely.
• There were no risk assessments in place for hazardous chemicals used onsite.
• Although recruitment checks were in place, some checks, required by legislation, were not completed.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines.
• CQC comment cards and patients with spoke with on the day mostly told us that staff involved and treated them with dignity and respect. Data from the GP survey shows that patient were less satisfied in these areas.
• Patients’ views on the appointments system were mixed.
• The practice monitored performance however, for some performance areas, such as patient satisfaction data, there were no plans to address this.
• The lead GP was key in many of the practice processes and there was no firm contingency plan for unexpected absence.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Continue to monitor and review practice performance and complete action plans for areas of lower performance.
• Consider a contingency plan for unexpected absence of the lead GP.
• Review patients satisfaction data to identify where improvements could be made.

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 Paul Moss Surgery on 01 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing, safe, effective, caring, responsive and well-led services. It was also good for providing services for the older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), for people whose circumstances may make them vulnerable, and people experiencing poor mental health (including people with dementia).

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

• Staff understood how to report significant events and to raise concerns. We found that action had been taken in response to safety alerts. Actions were also taken following investigations into significant events, and these were reviewed to evaluate their impact.
• Risks to patients were assessed and well administered, with evidence of action planning and learning when needed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients told us they were treated with compassion, dignity and respect and the majority said they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The majority of patients said they found it relatively easy to make an appointment with a GP and that there was continuity of care. We were told urgent appointments were available the same day.
• The practice had appropriate facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff told us they felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on. The practice sought feedback from patients through a patient participation group and a patient survey in relation to the services provided.
• We saw the business continuity plan in action due to the computer patient record system not working when we arrived at the practice. The contingency of working with laptops that had been backed up with the most recent records enabled clinicians to continue working and meant patient care was not compromised during this time.

We saw one area of outstanding practice:

• The practice provided specialist substance misuse treatment, and care for patients. The clinicians had specialist training and reception staff members were trained to support these patients. When the local area service stopped the practice continued to provide this service for their patients. They told us patients had registered at the practice to ensure their access to the substance misuse clinic. By continuing to provide this service to their own patients, continuity of care, with familiar staff members locally was provided. The practice dealt with aspects of substance misuse, in collaboration with the local Community Drug and Alcohol Service (CDAS) to support the patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Paul Moss (North Shoebury Surgery) on 16 April 2019 as a follow up to our inspection in March 2018 when the practice was rated as requires improvement for delivering safe services and caring services. The practice was rated as requires improvement for all of the population groups and requires improvement overall.

The practice was rated as requires improvement because:

• Systems relating to the security of prescription stationery required strengthening.
• Procedures around recruitment checks required review.
• Although incidents were reported and investigated, there was a lack of information on actions that the practice had taken to reduce the risk of a reoccurrence.
• There was no risk assessment regarding the hazardous chemicals used within the practice.

At the inspection we found that these areas had been improved to a satisfactory standard.

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 good overall and good for all population groups.

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The practice had implemented QOF action plans and unverified data from 2018-2019 showed that there was an improvement in patient outcomes.
• The practice had identified 80 patients as carers which amounted to 2.2% of their practice list.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Clinics had been organised at the church hall next door to the practice to review patients who did not usually engage directly with the practice.
• There were high levels of staff satisfaction. Staff were proud of the practice as a place to work and spoke highly of the culture.
• The practice carried out regular clinical meetings to ensure clinicians were up to date with current evidence-based practice. Clinicians received regular peer reviews using the Royal College of General Practitioners tool kit to ensure they were working within current guidelines and to highlight areas of improvement.
• There was a focus on continuous learning and improvement at all levels of the organisation. Staff were encouraged to share responsibilities, develop their roles and attend training.

Whilst we found no breaches of regulations, the provider should:

• Proceed with plans to replace carpet flooring in the treatment rooms with flooring that complies with infection control guidance.
• Continue to review the information stored on the home page of patient records
• Continue to work in partnership with Southend Clinical Commissioning Group (CCG) to further reduce the prescribing rate for co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of prescription items for selected antibacterial drugs.
• Continue with the Patient Group Directives (PGDs) process to ensure they comply with the guidance.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care