This practice is 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) - Good

We carried out an announced comprehensive inspection at Dr Peter Linn’s on 16 March 2018. We carried out a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is 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

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.
• National data showed that the practice was performing in line with national averages for all indicators. However the practice had a higher exception reporting rate than the national averages for some indicators.
• The practice involved patients in regular reviews of their medicines. In some cases we found patients had not had a medicine review within the recommended time scale.
• We found the practice had appropriate systems in place to monitor cold chain however they were unable to monitor medicine temperatures that were kept at room temperature. Since the inspection the practice have installed a thermometer to monitor room temperature.
• 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.
• Staff had received mandatory training applicable to their role. However the infection prevention control lead had not carried out any role specific training pertinent to the lead role.
• The practice provided staff with ongoing support. Although most members of the practice team had appraisals within the last 12 months, we found one member of the nursing team who had been at the practice for 18 months had not received an appraisal.
• There was sufficient and appropriate equipment for use in the treatment of patients, including in the event of a medical emergency and the equipment was calibrated to ensure it was working correctly.
• Staff we spoke with on the day said although they had individual team meetings they would benefit from having regular practice meetings to ensure general information and shared learning is cascaded regularly.
• The practice had identified 1.2% of its practice list as carers by highlighting them during registration and during clinical consultations.
• The practice was clean and tidy and staff had reviewed infection prevention control and policies.
• Data from the national GP patient survey published in July 2017 showed patients rated the practice in line with or higher than others for all aspects of care.
• The practice was aware of their patient population needs and their preferences and worked to accommodate them.
• There was a strong focus on continuous learning and improvement for the GP team. However we found there was no plan for staff development for administration or nursing staff members.
• Patients spoke highly of the care they had received from the entire team at the surgery.

The areas where the provider should make improvements are:

• Continue to establish effective systems to ensure medicine reviews are conducted and documented in line with standard practice.
• Review levels of exception reporting.
• Review processes to ensure all staff receive appraisals necessary to support them to carry out their duties and to encourage future development.

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 Peter Linn (also known as Angel Lane Surgery) on 8 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive 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), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• 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 said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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.

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

The provider should

• Conduct risk assessments for staff who undertake chaperone duties
• Improve patient recall arrangements to ensure patients’ needs are identified and met e.g. relating to diabetic patient checks
• Enhance staff understanding of adult safeguarding
• Ensure the business continuity plan provides sufficient detail on how services would be delivered in the event of an interruption of services and how this would be communicated to patients.
• Conduct joint clinical meetings for GPs and the nursing team to share knowledge and promote good practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with three people who confirmed that staff in the surgery maintained their privacy and dignity. One person told us, “A nurse came in with me while I was having an intimate procedure.” We saw that people were involved in decisions regarding their care and treatment. One person told us, “I have a great rapport, they listen and have time."

We saw that people were involved in their care and treatment. We spoke with four people, one of whom told us, “The GP we saw today printed everything out so we could see what she was talking about.”

There were appropriate arrangements in place for the obtaining, recording and auditing of controlled drugs. We spoke with one person, who was waiting at the dispensary who told us, “I get my scripts from here, it’s very good. I have no concerns. I think it is lovely.”

There was an effective system in pace for documenting, learning from and reviewing significant events and complaints.

We saw that records were kept securely and were updated regularly with details of the care, treatment and support provided in relation to the people who used the surgery. There was guidance for staff in relation to information governance.