Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Emmett Carr Surgery on 8 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report dated 8 November 2016 can be found by selecting the ‘all reports’ link for Emmett Carr Surgery on our website at www.cqc.org.uk.

We undertook an announced focused inspection on 8 May 2017 to confirm that Emmett Carr Surgery had carried out their plan, to meet the legal requirement in relation to the breach in regulation that we identified in our previous inspection. This report covers our findings in relation to the requirement and also additional improvements made since our last inspection.

.Overall the practice is now rated as good. Our key findings were as follows:

• The practice had completed their action plan to meet the legal requirement.

• The practice had adopted a more proactive approach to assessing and managing risks. For example robust procedures had been put in place for managing significant events and Medicines and Healthcare products Regulatory Agency (MHRA) alerts to ensure that all required actions had been completed, and that learning was shared with the practice team to prevent further incidents.

• Recruitment processes had been strengthened to ensure that appropriate pre-employment checks were obtained for all staff, along with evidence of their immunity status.

• The cleaning records had been updated to detail all tasks carried out and to show that regular spot checks were completed, to ensure that appropriate standards of cleanliness and hygiene were maintained.

• The practice had strengthened the governance arrangements for overseeing the quality of care and to mitigate risks. For example the clinical audit system had been developed to include more full cycle audits to drive improvements in patient care.

• The practice had established more formal meetings including regular clinical and business meetings, to aid communication, learning opportunities and improve the performance. All meetings were recorded to outline the issues discussed and responses and action points.

• A succession plan had been put in place which set out the arrangements to cover unforeseen illness or departure of key members staff, to ensure continuity of care and the future security of the practice.

In addition the provider should:

Further review documentation relating to induction and the appraisal process to ensure staff receive appropriate training and development to carry out their work.

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 Emmett Carr Surgery on 8 November 2016. Overall, the practice is rated as requires improvement.

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

• There was a system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients, although this was not routinely done as part of a formal meeting including the whole team. The process of signing off any actions taken following an incident required strengthening.
• The practice had systems in place to safeguard children. There was effective liaison with the health visitor to ensure that vulnerable children were kept safe.

• The practice team had the skills, knowledge and experience to deliver good quality care and treatment. Clinicians kept themselves updated on new and revised guidance although there was no dedicated meeting at which the team formally discussed clinical issues.
• We saw some evidence of a programme of clinical audit that reviewed care against specific criteria or guidance.
• Patients told us they were treated with compassion, dignity and respect, and said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey and CQC comment cards.
• The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. Fortnightly meetings took place to discuss and review patients’ needs.
• There were some arrangements in place to assess and manage risk. The identification of new or emerging risks required strengthening.
• Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that people were generally satisfied with access to GP appointments.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with mobility difficulties.
• Practice meetings took place on approximately five occasions during the year. Staff said that GP partners and the practice manager were approachable and always had time to talk with them.
• The partnership had produced a vision statement and had developed objectives for the service. There was not a clear strategy or formal business planning arrangements in place.
• The practice worked collaboratively with other practices and engaged with their Clinical Commissioning Group (CCG).
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice had an active patient participation group (PPG) which usually met on a quarterly basis, and worked with the practice to respond to patient feedback. The PPG helped the practice to design an annual in-house patient survey.

The areas where the provider must make improvements are:

• Strengthen the systems to enable the provider to have effective oversight of the quality of the service being provided and to mitigate identifiable risk. For example by ensuring internal meetings allow for discussion and learning from events and complaints; ensuring the practice policies are followed for example in relation to recruitment; minimising delays in identifying risks to patients by not responding directly to MHRA alerts; and considering succession planning as part of the practice strategy.

The areas where the provider should make improvements are:

• Review documentation to support staff inductions and the appraisal process.
• Review the content of practice cleaning schedules.
• Strengthen the systems to evidence the immunity status of staff
• Review the systems for clinical audit, and in particular the use of completed audit cycles to ensure improvements to patient care.
• Continue to review the patient feedback on access to a preferred GP, and assess the impact of steps being taken to address this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice