We carried out an announced comprehensive inspection of the Fortune Green Practice on 15 August 2018. We rated the practice as good for providing effective, caring and responsive services. We rated the practice as requires improvement for providing safe and well-led services, as we had concerns relating to infection prevention and control issues, safety checks and mandatory training for staff. The overall rating for the practice was requires improvement.

We served requirement notices relating to the practice’s failure to comply with Regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The full comprehensive report of the August 2018 inspection can be found by selecting the ‘reports’ link for the Fortune Green Practice on our website at www.cqc.org.uk/location/1-3832027886. After the inspection, the practice confirmed it had taken action to ensure it was able to meet the legal requirements under the key questions, Safe and Well-led.

Our visit on 13 December 2018 was a focussed inspection looking at the issues previously identified, to check and confirm that the practice implemented actions to address the concerns. We found that the practice had taken appropriate action to meet the requirements of the regulations relating to providing a safe and well-led service. Accordingly, we have revised the practice’s ratings in respect of the key questions Safe and Well-led to good and have revised its overall rating to good.

At the inspection we found:

• Staff had completed necessary mandatory training in safeguarding and infection prevention and control.
• Risk assessments, including those relating to fire safety and legionella had been carried out. Electrical equipment had been tested and services such as fixed wiring and the premises gas supply had been inspected.
• A defibrillator and a new vaccines fridge had been obtained.
• Logs had been introduced and were being maintained recording cleaning and safety checks.
• Areas of the premises had been cleaned and redecorated.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. The service was previously inspected on 20 January 2017, when it was rated Good overall and for the five keys questions and population groups. Since then it made changes to its registration, with one of the two former partners becoming the sole practitioner.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection on 15 August 2018, as the first scheduled inspection of the newly-registered practice.

At the inspection we found:

• We identified a number of issues relating to health and safety at the practice that required action. These included the need to carry out effective fire and general health and safety risk assessments, matters relating to infection prevention and control, medicines management and some staff not having appropriate level training and refreshers.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided to ensure that care and treatment was delivered according to evidence-based guidelines.
• Published data showed that cervical screening rates and the take up of childhood immunisations was below average. Exception reporting in relation to patients with diabetes was above average.
• 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.
• The practice reviewed feedback from the GP patient survey and Friends and Family test, but had not conducted its own patient surveys since 2016.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue with efforts to increase patients’ uptake of the cervical screening and childhood immunisation programmes and to engage with patients with diabetes to improve outcomes.
• Review the process for seeking and acting on feedback from patients.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice