Letter from the Chief Inspector of General Practice

On 8 March 2017 we carried out a comprehensive inspection as a follow up to the practices first inspection on 29 June 2016 where they were placed in special measures. In March 2017 we found the practice had made improvements and had improved from an overall rating of inadequate to requires improvement. The practice was rated as requires improvement in March 2017 for providing caring and responsive services and rated as good for providing safe, effective and well-led services. The full report for the June 2016 and March 2017 inspections can be found by selecting the ‘all reports’ link for Dr Tony Nasah on our website at www.cqc.org.uk.

We carried out a focused inspection of the practice on 18 September 2017 to establish whether the improvements towards caring and responsive services had been made. We found the practice had made appropriate improvements for providing responsive services; overall the practice is rated as good with requires improvement for providing caring services.

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

• Patients satisfaction data from the national GP patient survey, published in July 2017, had positive and negative variation. The practice were performing in line with local and national averages for their responsive data however they were performing below local and national averages for some aspects relating to the caring domain.
• The practice had created an action plan to improve their patient satisfaction.
• The practice had conducted internal patient surveys to monitor patient satisfaction. 64 out of 100 survey questionnaires were completed of which all had positive feedback.
• The practice had recruited two GPs and a nurse to increase appointment availability and to allow clinicians more time when discussing patients care.
• Patients we spoke with on the day of the inspection were positive towards their care they received at the surgery.
• Staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.

Actions the practice SHOULD take to improve:

• Continue to monitor national GP patient survey data and identify where improvements can be made.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 29 June 2016, we carried out a comprehensive announced inspection. We rated the practice as inadequate overall. The practice was rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring and responsive services. As a result of the inadequate rating overall the practice was placed into special measures for six months.

A warning notice was issued for the provider for good governance. The concerns related to the safe recruitment of staff, appropriate staff training and support, management and learning from significant incidents, safe management of medicines and clinical performance. The practice submitted an action plan in respect of the regulatory breaches identified.

Practices placed into special measures receive another comprehensive inspection within six months of the publication of the report, so we carried out an announced comprehensive inspection at Dr Tony Nasah on 8 March 2017 to check whether sufficient improvements had been made to take the practice out of special measures. At this inspection we also looked at whether the practice had complied with the warining notice and we found that the improvements had been actioned.

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

• We saw staff were confident reporting significant incidents and these were investigated, learning shared and acted upon.
• Patient safety and medicines alerts information was shared and appropriate changes to patient’s medicines had been made.
• Staff had appropriate recruitment checks and those undertaking chaperone duties had undertaken DBS checks.
• Medicine management arrangements in place kept patients safe.
• Risk assessments had been conducted, actions identified and addressed to mitigate risks to patients.
• The practice had arrangements in place to respond to emergencies.
• Data from the practices performance over the past 12 months and the Quality and Outcomes Framework (QOF) showed improvements.
• The practice had established a culture of administrative and clinical audits to assess practice performance and ensure care was being delivered in line with current evidence based guidance.
• The clinical team had defined roles and responsibilities. They had the skills, knowledge and experience to deliver effective care and treatment.
• All staff had received appraisals and personal development plans.
• The practice received 60 comment cards which were positive about the commitment and care they received from the practice team.
• Patients reported improved levels of satisfaction with their GP in the national GP patient survey published July 2016.

• The practice had identified 2% of their registered patients to be carers and informed them of service available to them such as annual flu vaccinations.

• Practice provided a range of services from telephone consultations, extended hours an access to the GP hub every evening and weekends for GP, practice nurse and healthcare assistant services.
• Patients reported improved satisfaction with the GPs at the practice in the national GP patient survey.
• Appointments were available with GPs and the practice nurse on the day of the inspection and the following day with the healthcare assistant.
• Information about how to complain was available for patients. The practice acknowledged, investigated and responded to complaints. Learning from complaints was shared with staff and other stakeholders during meetings.
• The practice had published values and was clear about their future plans for development of the service.
• There was visible leadership within the practice and established governance systems. Risks to patients and staff were identified and acted on.
• The practice acted on feedback from patients and had patient representation at their patient participation meetings.

However there was an area of practice where the provider should make improvement:

• Improve patient satisfaction rates as highlighted in the national GP patient survey.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 8 March 2017 we carried out a comprehensive inspection as a follow up to the practices first inspection on 29 June 2016 where they were placed in special measures. In March 2017 we found the practice had made improvements and had improved from an overall rating of inadequate to requires improvement. The practice was rated as requires improvement in March 2017 for providing caring and responsive services and rated as good for providing safe, effective and well-led services. The full report for the June 2016 and March 2017 inspections can be found by selecting the ‘all reports’ link for Dr Tony Nasah on our website at www.cqc.org.uk.

We carried out a focused inspection of the practice on 18 September 2017 to establish whether the improvements towards caring and responsive services had been made. We found the practice had made appropriate improvements for providing responsive services; overall the practice is rated as good with requires improvement for providing caring services.

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

• Patients satisfaction data from the national GP patient survey, published in July 2017, had positive and negative variation. The practice were performing in line with local and national averages for their responsive data however they were performing below local and national averages for some aspects relating to the caring domain.
• The practice had created an action plan to improve their patient satisfaction.
• The practice had conducted internal patient surveys to monitor patient satisfaction. 64 out of 100 survey questionnaires were completed of which all had positive feedback.
• The practice had recruited two GPs and a nurse to increase appointment availability and to allow clinicians more time when discussing patients care.
• Patients we spoke with on the day of the inspection were positive towards their care they received at the surgery.
• Staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.

Actions the practice SHOULD take to improve:

• Continue to monitor national GP patient survey data and identify where improvements can be made.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice