Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Friargate Surgery on 10 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety within the practice. Effective systems were in place to report, record and learn from significant events. Learning was shared with staff and external stakeholders where appropriate.

• Risks to patients were assessed and well managed. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• The practice demonstrated innovation in managing care to achieve better outcomes for their patients by securing an audible blood pressure monitor for a patients with sight problems to manage their health at home.

• Training was provided for staff which equipped them with 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.

• GPs demonstrated a caring approach by convening multi-practice multi-disciplinary meetings to coordinate care and tailor it to the needs of patients.

• Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• Feedback from the GP patient survey was in line with local and national averages.95% of patients stated they had confidence in the last GP they saw or spoke to.

• 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 and learning from complaints was shared with staff and stakeholders.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Services were designed to meet the needs of patients.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. The partners held quarterly meetings where all staff were involved.

However, the areas where the provider should make improvements are:

• Consider developing a patient participation group is established to encourage patient-led engagement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On this occasion, we did not speak with any people using the service in regards to the standards we inspected.

We found that the provider had made the required improvements since our previous inspection in May 2014.

The practice was visibly clean and hygienic, and effective systems were in place to protect patients and staff against the risk of infection.

The systems for managing medicines had been strengthened to ensure they were handled safely and appropriately.

The provider had put effective systems in place to monitor the quality of the service in regard to the management of medicines and cleanliness and infection control to ensure the welfare and safety of patients.

Following our visits to the location on 09 and 17 July 2013 we asked the provider to make some improvements. The provider sent us an action plan telling us they had made the necessary improvements, and this visit was to check to see if those improvements had been made.

We spoke with two patients during this visit. Both of them told us they felt safe and well cared for and that staff treated them with respect. They also told us they felt that the surgery was kept clean and tidy.

We found there had been improvements in regard to protecting patients from the risk of abuse. Staff had received training in this area and they were aware of policies in place and their responsibilities. We also found there had been improvements in regard to developing effective communication systems.

Whilst there had been improvements in regard to infection control policies and procedures, we had concerns about staffs knowledge and understanding of these. We also found there were still some areas of concern in regards to the cleanliness and infection control of the premises, and the provider’s auditing systems had not identified these.

We found there had been some improvements in regard to the management, storage and safe keeping of medicines. However, again there were concerns in respect of staffs knowledge and understanding of the medicine policies, and in regard to the disposal of medicines and audits undertaken.

The provider’s quality assurance systems had failed to recognise that effective audits were not taking place to identify issues of concern in regard to infection control and the management of medicines. This meant that effective systems were not in place to identity and manage risks relating to the health, safety and welfare of the patients who used the service.

We spoke with six patients, who told us they were treated with care and respect. One patient told us “I’m happy generally with the practice and staff.” Patients expressed differing views about whether they were able to see a GP when they wanted to. The main concern expressed by patients was being unable to get through on the telephone to make appointments, and not being able to make appointments for than a week in advance.

Patients told us they felt listened to and involved in their care. Treatment options were discussed and test results fully explained. Patients said “The doctor explains things well and I can really trust them” and “I feel they listen and have time to discuss things.”

Staff we spoke with did not know what actions they should take if they had concerns a patient or their relative was unsafe or at risk of abuse.

We found the practice did not have appropriate systems in place to monitor medicines or help prevent the spread and risk of infection. Staff we spoke with had not received training in infection control and the correct equipment was not available to help them protect people from the risk of infection.

Patients were asked for their views about their care and treatment and they were acted upon. However, we found communication between staff was not effective. The practice did not routinely hold staff meetings and staff spoken with were unclear about policies and procedures in place.