Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Williams, Lamb and Johal (Russell House Surgery) on 15 August 2016. Overall the practice is rated as Good.

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 Care Quality Commission (CQC) at that time.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded and reviewed but subsequent actions were not always seen to have been agreed and completed.
• Risks to patients and staff were assessed and the health and safety systems were generally well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles but some staff were unaware of the Mental Capacity Act.
• Patients spoke of a personal service and the national GP patient survey scored the practice in line with local and national averages for questions relating to care.
• Information about services and how to complain was available and easy to understand. Written complaints were well managed but verbal complaints were not logged or reviewed.
• Patients told us they could get an appointment when they needed one. Urgent appointments were available the same day. However patient feedback consistently highlighted a problem with telephone access.
• 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, patients and third party organisations, which it acted on.
• Education and shared learning were evident but there was no systematic process to monitor outcomes.

There were areas of practice where the provider should make improvements:

• Implement an effective patient recall system that offers annual health checks to patients with learning disabilities.
• Ensure that risks identified from significant events and incidents are well managed and ensure that record keeping reflects actions in place to mitigate risk.
• Complete health screening on new staff to identify underlying conditions that may affect their capacity and/or require adaptations to their working environment.
• Ensure there are adequate arrangements in place to access, manage and monitor emergency medicines including emergency medicines kept in GPs’ bags.
• Review the training programme to ensure that staff gain the appropriate knowledge from courses completed.
• Consider how confidentiality of conversations taking place at the reception desk could be improved.
• Continue to identify carers and ensure that carers provided further support where needed in a variety of hard copy, electronic and accessible formats.
• Monitor themes from verbal and written complaints to identify further areas for improvement and maximise opportunities to share learning.
• Consider and explore ways of how to improve patient satisfaction in relation to telephone access and opening hours.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with seven patients and five members of staff. One patient said, “Never had a problem - really helpful and accommodating." Some of the patients we spoke with said they were unable to obtain appointments at a time to suit their needs. However, all the patients we spoke with said they felt the quality of care they received was good..

We saw that patient's views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. One patient told us, “I have always been really happy here." We saw that patients experienced care and treatment that met their needs. Patients told us and we saw that care was delivered in a clean environment.

Staff were knowledgeable about safeguarding (protecting vulnerable adults and children) and were aware of whom to report concerns to.

Improvements were required to the quality monitoring systems to assess and monitor the quality of service that patients received. There was not an established method to obtain patient feedback to improve the quality of service delivered. The systems of incident and accident reporting required improvement.

We carried out an announced comprehensive inspection at Russell House Surgery on 13 December 2018 as part of our inspection programme. Drs Williams, Lamb and Johal are known as Russell House surgery locally.

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.

We found that:

• 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.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found one area of innovative practice:

• One of the practice nurse had taken a proactive approach to obesity and the associated risks of developing diabetes. The practice supported patients with a specific diet, and monitored the effects carefully. All patients who tried the diet reported significant weight loss and improved wellbeing.

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

• Continue to improve the identification of carers to enable this group of patients to access the care and support they need.
• Further develop clinical audit to support quality improvement.
• Support Infection Prevention and Control work with dedicated time.
• Follow their policy for temporary staff.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice