Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection January 2017 – Requires Improvement)

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 follow-up inspection at St Andrews Surgery on 14 November 2017. At our previous inspection on 10 January 2017 the overall rating for the practice was requires improvement. The full comprehensive report from the January 2017 inspection can be found by selecting the ‘all reports’ link for St Andrew Surgery on our website at www.cqc.org.uk. We conducted a further comprehensive follow-up inspection visit on 14 November 2017 and found improvements had been made. The report on the November 2017 inspection can be found by selecting the ‘all reports’ link for St Andrew Surgery on our website at www.cqc.org.uk.

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.

• 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.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• The practice implemented service developments using input from clinicians to understand their impact on the quality of care.

• The practice had implemented a new on-line electronic system for patients to allow them to log into the practice system from their own home and self-assess their current condition which consulted with a GP.

The areas where the provider should make improvements are:

• Consider the lead person identified for infection and prevention control receives appropriate training for the role.

• Consider that nursing staff have completed on-going competency assessment and supervisions.

• Consider implementing additional systems to ensure all staff are aware of what actions are taken, by whom and by when to enable learning from significant events.

• Consider a system for refrigerator temperature checks is regularly maintained.

Consider implementing systems to ensure patient access to appointments is improved.

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 St Andrews Surgery on 10 January 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Some risks to patients were not always assessed and well managed.
• Staff assessed patients’ needs and delivered care. However, there was limited documented evidence that a formal process was in place to review and assess clinical guidance when it was issued. 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Some patients said they found it difficult to make an appointment and with a named GP. Urgent appointments were available the same day using an on-call duty doctor system.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure an overarching governance framework which supports the delivery of good quality care is put in place and to ensure risks and issues are always identified and dealt with appropriately or in a timely way.

The areas where the provider should make improvements are:

• Implement a system to ensure patients’ treatment was reviewed and updated if necessary following the issuing of updated clinical guidelines.

• Implement a process so patient records are summarised in a timely manner.

• Put systems in place for identifying and completion of appraisals for all staff in order for them to carry out their duties effectively and safely.

• Implement a process so all staff are aware of the procedures regarding safeguarding within the practice, including who is the lead for safeguarding within the practice.

• Implement systems to ensure infection control actions are completed and monitored in a timely manner.

• Ensure arrangements are in place for business and succession planning including a mission statement and practice values.

• Develop a business continuity plan to ensure continued provision of services in the event of unforeseen emergencies.

• Implement a system to conduct an analysis of all complaints to assess the trends and impact on patients and the service.

• Implement a system to ensure new starters joining the service undertake a role specific formal induction to ensure staff carry out their duties effectively and safely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice