Letter from the Chief Inspector of General Practice

When we visited Dr Robertson and Partners at Marcham Road Health Centre on 30 March 2016 to carry out a comprehensive inspection, we found the practice had breached regulations relating to safe care and treatment and good governance. The practice was rated as requires improvement for safe and well-led, and good for effective, caring and responsive. Overall the practice was rated as requires improvement.

Following the inspection the provider sent us an action plan that set out the actions they would take to meet the breached regulations.

This focused inspection was undertaken on 21 December 2016 to check the practice was meeting the regulations previously breached and to see if they had taken action on other areas we recommended the provide should address. For this reason we have only rated the location for the key questions to which this inspection related. This report should be read in conjunction with the full inspection report of our inspection in March 2016. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Dr Robertson and Partners our website at www.cqc.org.uk.

We found the practice had made improvements since our last inspection. The information we received enabled us to find the practice was meeting the regulations that it had previously breached.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

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 Robertson and Partners on 26 February 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and well led services. It is also rated as requires improvement for older people, people with long term conditions, families children and young people, working age people, people whose circumstances may make them vulnerable, people experiencing poor mental health.

The practice is rated as good for providing an effective, caring, and responsive service. Our key findings across all the areas that we inspected are as follows:

• Staff understood their responsibilities to raise concerns and this information was recorded, monitored, reviewed and addressed. 
• Appropriate procedures relating to the management of medicines were not always in place.
• Data showed patient outcomes were average for the locality and audits had been carried out.
• Most patients said that 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. However, the complaints policy was not always followed by staff.
• Urgent appointments were usually available, but patients said that they sometimes had to wait one to two weeks for non urgent appointments with a preferred GP.
• Processes for assessing and monitoring risks to patient safety were not always satisfactory.

The areas where the provider must make improvements are:

• The practice must ensure medicines and related stationary are safely managed and appropriate records kept.
• The practice must ensure that there are systems to identify, assess, and manage risks relating to the health, welfare, and safety of patients, and others who may be at risk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Dr Robertson and Partners (known as Marcham Road Family Health Centre) is a GP practice situated on the site of Abingdon Community Hospital. The practice has approximately 12,500 registered patients. The practice provides a range of primary care services for patients.

We spoke with patients about their experiences of care at this practice and also looked at written feedback from patients about the quality of services. All of the patients we spoke with gave positive feedback about the practice and staff. We reviewed the results of the last patient survey undertaken in 2014. This showed patients were generally pleased with the service they received, but highlighted some areas for development. For example, making an appointment. The practice had taken steps to address these areas.

The practice was patient-focused in its approach to care and treatment. It provided information and support to help patients understand their care and treatment and help them make informed choices. The practice ran a number of specialist clinics to help patients manage their long term conditions. GPs and nurses had specialist areas of interest and provided advice and support to other GPs and nurses within the practice.The practice opted out of providing out of hours primary medical services for its patients. Outside of surgery hours patients were able to access emergency care from another Out of Hours service.

We found the practice did not operate effective systems to reduce the risk and spread of infection. The practice had an infection control lead and appropriate infection control policies and procedures. However, staff did not always following the procedures and audits to identify risk of infection were not regularly conducted. We found the provider was in breach of the regulation relating to infection control.

The practice met the needs of the population it served. Older patients at the practice had a named GP who oversaw their health and care needs. GPs conducted home visits to ensure patients who had difficulty accessing the practice received appropriate care and treatment. Patients with long term conditions told us their conditions were managed well. GPs and nurses had specialist areas of interest and training for long term conditions and provided specialist clinics to patients. Mothers and babies were supported by a service which had links with the local health visitors. Child immunisation clinics were run regularly.

The practice offered regular health checks to patients with poor mental health and patients with a learning disability. Patients who were carers were identified and offered additional support. The practice offered online appointment booking to ensure patients could access the service in a variety of ways. The practice did not offer any late evening or weekend opening to enhance access to patients who worked.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.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Robertson and Partners, also known as Marcham Road Family Health Centre, on March 30, 2016. Overall the practice is rated as requires improvement.

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.
• Risks to patients were assessed and well managed, with the exception of those relating to patient safety alerts encompassing all clinical areas, cleanliness in clinical areas, and some aspects of medicine management in the dispensary.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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 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. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice had proactively sought feedback from patients and had an active patient participation group.
• Governance procedures were found to require improvement to ensure that procedures were effectively implemented and monitored, and to allow partners to have appropriate time to focus on non-clinical duties, such as complying with CQC registration requirements.

The areas where the provider must make improvements are

• Review governance procedures to ensure that risk assessments are undertaken and policies put in place to include Legionella.

• Review cleaning procedures to ensure appropriate cleaning is undertaken in all clinical areas.

• Ensure all patient safety alerts are circulated in the practice and actions taken recorded.

• Undertake a review of dispensing systems and processes to minimise risk to patients.

• Risk assess the home delivery of medicines to ensure safe storage, transport and dispensing of medicines.

• Review training for all staff working in the dispensary.

• Review regular and robust checks on controlled drugs.

In addition the provider should:

• Review the process for identifying carers in order to increase the number of patients identified as carers and provide additional support.

• Work to increase the number of patients with a diagnosed mental health condition attending for annual review.

• Review access to appointment for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice