This practice is rated as

Good overall. (Previous inspection July 2017 – Good overall, with requires improvement rating for providing Safe services)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services well-led? – Good

We inspected Great Bridge Partnerships for Health on 28 April 2016. As a result of our inspection, the practice was rated as requires improvement overall with a requires improvement rating for providing effective, caring and well led services; the practice was rated good for providing safe and responsive services. A requirement notice was issued to the provider. A second announced follow up inspection was carried out on 20 July 2017, in order to review progress made by the practice. The practice was rated requires improvement for providing safe services. The practice was rated as good for providing effective, caring, responsive and well led services and rated good overall. You can read the reports from our previous inspections by selecting the 'all reports' link for Great Bridge Partnership for Health on our website at www.cqc.org.uk

This inspection was an announced focused inspection carried out on 16 August 2018. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified at the previous inspection. As part of this inspection we also reviewed if the practice was providing a well led service. This report covers our findings in relation to those requirements.

At this inspection we found:

• The practice had improved its safeguarding processes to ensure concerns about children and vulnerable adults were easily identifiable and could be acted on.
• Records for the maintenance of the premises was accessible and could be referred to as required.
• Patients records reflected if they were on high risk medicines or had major active problems.
• The system for recording and learning from significant events was not always clear or consistent to support learning and improvements.
• The practice had taken action to improve patient satisfaction in relation to accessibility and monitored this through surveys. However, patient feedback showed ongoing improvements were required.

The areas where the provider should make improvements are:

• Ensure the system for recording and learning from significant events is clear and consistent to support learning and improvements.
• Ensure learning from patient’s safety alerts is shared with all staff.
• Continue acting to improve patient satisfaction in relation to access to appointments and getting through to the practice by phone.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We previously inspected Great Bridge Partnerships for Health on 28 April 2016. As a result of our inspection visit, the practice was rated as requires improvement overall with a requires improvement rating for providing effective, caring and well led services; the practice was rated good for providing safe and responsive services. A requirement notice was issued to the provider. This was because we identified a regulatory breach in relation to regulation 9, Person-centred care and also in relation to regulation 17, Good governance. We identified some areas where the provider must make improvements, as well as areas where the provider should make improvements.

We carried out an announced comprehensive inspection at Great Bridge Partnerships for Health on 20 July 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Great Bridge Partnerships for Health on our website at www.cqc.org.uk.

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

• There were processes in place for formally reporting incidents and systems ensured compliance with the requirements of the duty of candour. Significant events and complaints were discussed with all staff and reflected on further during the partnerships quarterly clinical governance meetings.

• During our inspection we found that the practices systems to support effective safeguarding processes were not always effective. For instance, we found that safeguarding registers were not adequately maintained and the content was unclear in specific areas.

• We saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

• Practice data indicated that the practice consistently met Quality and Outcomes Framework (QOF) targets and had made improvement with regards to mental health performance.

• We noted that in some areas the practice were not maximising the use of their patient record system to notify staff when patients were on certain high risk medicines and to highlight patient’s major active problems.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Ensure patients are protected from abuse and improper treatment

The areas where the provider should make improvements are:

• Maximise the use of the patient record system to ensure staff are notified when patients are on high risk medicines and to highlight patient’s major active problems.

• Ensure timely access to key documents associated with the practice premises for the service provided at Yew Tree Healthy Living Centre Surgery, to support areas such as premises safety and maintenance.

• Continue to work on areas identified for improvement from internal and external patient surveys.

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 Great Bridge Partnership on 28 April 2016. 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.
• Risks to patients were assessed and well managed.
• The practice had a programme of clinical audits. .
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The majority of patients said they were treated with compassion, dignity and respect.
• The practice had not taken action to address the areas of low satisfaction from the national patient survey. 
• Information about services and how to complain was available and easy to understand. Improvements were made as a result of complaints and concerns.
• Patients said it was difficult to make an appointment with a named GP, which affected continuity of care, however urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff felt supported by management. The practice had an active patient participation group (PPG) and acted on feedback provided from the PPG.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• The provider must have effective systems to enable them to assess and monitor the quality of the service by; actively seeking and act on views of people who use the service, about their experience and quality of the care and treatment delivered in order to improve the quality of the service.

• The provider must ensure care and treatment provided to patients is appropriate, meets their needs and reflects their preferences by ensuring care plans are sufficiently detailed and updated following changes in their circumstances.

The areas where the provider should make improvements are:

• The provider should take more proactive steps to promote bowel and breast screening in the practice.

• The provider should investigate the reasons for high exception reporting in mental health indicators and take more proactive steps to ensure patients are recalled and monitored.

• The provider should put systems in place to monitor improvements following the installation of additional telephone lines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice