Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Flather and Partners (also known as Hadleigh Boxford Practice Group) on 31 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for the six population groups it serves.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles. Most staff had received an appraisal to identify and plan further training needs.
• Patients told us they valued the services provided to them.  Staff treated them with compassion, dignity and respect and they were involved in their care and treatment decisions.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment and that there was continuity of care. Urgent appointments were available on the same day.
• The practice had good facilities and had established relationships with other health and care professionals. They were well equipped to treat patients and meet their needs.
• 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.

We saw one area of outstanding practice:

• The practice had signed up to a local initiative for being a dementia friendly town. They had completed some refurbishment of the premises to make it easier for patients with dementia to orientate themselves within the building.

However there were areas of practice where the provider needed to make improvements.

Importantly the provider should:

• Record the relevant meetings to demonstrate that medicines incidents are monitored, trends are identified and action is taken to reduce any risk of reoccurrence.  
• Provide additional training for the infection control lead and provide protected time for the role.
• Review the arrangements for sharing and discussing changes in best practice guidelines with all relevant staff and the implications for the practice.
• Review clinical meetings so that all clinical staff have regular opportunities to review clinical care and practice.
• Ensure that all non-clinical staff receive annual appraisals.
• Complete an audit to ensure that people's consent to treatment is recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hadleigh Boxford Group Practice on 23 October 2018 as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor, a member of the CQC medicines team and a practice manager specialist advisor.

The practice was last rated in June 2015 and was rated as Good.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

This means that:

• People were protected from avoidable harm and abuse and legal requirements were met. Risk assessments were completed and actioned.
• Some patient safety alerts had not been recorded, but had been actioned and patients had been reviewed appropriately.
• Many meetings were held and recorded; however, it was unclear from meeting minutes which staff attended multidisciplinary team meetings.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• The practice had set up a charitable trust which had provided a sensory room for a local care home, a private lymphedema nurse, access to cognitive behavioural therapy in addition to other support.
• The practice were high achievers for the Quality and Outcomes Framework and the national GP patient survey.
• Patients at the end of life received appropriate care and treatment.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• The practice were active in the community and provided education sessions on careers in healthcare, diabetes management and ‘dying: it matters’, an end of life educational programme.
• The practice worked closely with the care homes in the local area and provided weekly visits, as well as pharmacist reviews of medicines.
• People were able to access the service easily and this was reflected in above average survey outcomes.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
• The practice actively engaged with the patient participation group and implemented changes to care as a result of their input. For example, an ‘inactive to active’ initiative.

We rated the practice outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. There was a proactive approach to understanding the needs and preferences of different groups of people across all population groups and to delivering care in a way that met those needs. For example, the practice worked to support people recently diagnosed with diabetes and with local care homes to deliver tailored education to care home staff. Patient feedback was consistently very positive and the GP patient survey results were consistently above local and national averages and significantly higher for indicators relating to patient’s needs being met and the type of appointments offered.

Whilst we found no breaches of regulations, the provider should:

• Embed the new system for the documentation for recording the actioning of patient safety alerts and multidisciplinary team meetings.
• Review systems in place to ensure staff are appropriately following standard operating procedures within the dispensary.

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

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