Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at First Care Practice on 11 October 2016. The overall rating for the practice was requires improvement. We also rated the practice as requires improvement for providing caring and responsive services and issued a requirement notice in relation to a breach of regulation 17. This was because the practice could not demonstrate it had sufficient staff capacity to meet the needs of patients and provide an accessible service.

We also noted that the practice:

• scored consistently below the local and national averages on the 2016 national GP patient survey
• had identified fewer than 1% of its patients as carers.

The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for First Care Practice on our website at www.cqc.org.uk.

This inspection was a focused inspection carried out on 11 December 2017 to confirm that the practice had made improvements since our last inspection and was now meeting legal requirements.

We also followed up concerns received by the Care Quality Commission about the quality of care and leadership at the practice.

Following this inspection, we have rated the practice as good overall. We have rated the practice as good for providing caring and responsive services. We did not find evidence to substantiate the concerns which had been reported to us and the practice's ratings for providing safe, effective and well-led care remain as good.

Our key findings were as follows:

• Since our previous inspection, the practice had increased its clinical capacity and the number of GP and nursing sessions it provided each week. 
• The practice now used regular salaried or locum clinicians to facilitate continuity of care for patients with complex or longer term conditions. 
• The practice promoted telephone consultations where appropriate and online appointment booking to better manage demand.
• The practice's results on the national GP patient survey remained below average in 2017. However, the practice had noted the response rate to this survey was low and had carried out its own survey of patients which showed improving satisfaction levels.
• The practice had increased the number of patients it had identified as carers to 91. The practice offered carers additional support and flexibility in making appointments.
• The practice provided a responsive service. It had a young population and had identified health promotion and lifestyle advice as a key priority for this population group.
• The practice was looking at innovative ways to support and engage patients to manage their own health where appropriate.
• The practice provided an accessible service. The practice was open seven days a week and over public holidays. Emergency and same day appointments were available for patients who required more urgent access.

The areas where the practice should make improvement are:

• The practice should review and, if appropriate, work to reduce its exception reporting rates for cervical screening which were relatively high in 2016/17.

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 First Care Practice on 11 October 2016. Overall the practice is rated as requires improvement.

Specifically, we found the practice as good for safe, effective and well led and requires improvement for caring and responsive. It was requires improvement for providing services for; older people, people with long-term conditions, families, children and young people, working age people, people whose circumstances make them vulnerable and people experiencing poor mental health.

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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Some arrangements were in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs, however, patient feedback was that they could not always get an appointment with a GP of their choice. Two permanent GPs, left the practice during the past 12 months, within a few months of each other. The practice’s current clinical team consist of one male GP, four GP locums (3 male and 1 female). The GPs are supported by a clinical team consisting of one nurse practitioner, one practice nurse, one community nurse matron, three health care assistants and one notes summariser.
• Two of the seven patients we spoke with on the day of the inspection said they were treated with compassion, dignity and respect; however, they felt that not all changes made in the practice were communicated to patients.
• Data from the national GP patient survey showed patients rated the practice lower than others for some aspects of care, for example, access to a named GP, involving patients in decisions about their care and being able to get through to the surgery by phone.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice sought feedback from staff and patients; however, two of the seven patients we spoke with on the day of the inspection felt that their concerns were not always acted on by the practice. 
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Improve the arrangements in place for planning and monitoring the number of staff and the staffing mix.

The areas where the provider should make improvement are:

• Improve patient experience, including but not limited to; involving patients in decisions about their care, telephone access to the practice, access to a named GP of their choice and explaining tests and results se as identified in the GP Patient survey (July 2016).

• Review arrangements in place to ensure that patients with caring responsibilities are identified, so their needs are identified and can be met.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice