Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Haverthwaite Surgery on 26 May 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 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 the skills, knowledge and experience to deliver effective care and treatment.
• Patients were highly satisfied with their care. For example, 97% said the last GP they spoke to was good at treating them with care and concern (CCG average 89%, national average 85%). Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. 100% of patients who responded to the National GP Patient Survey said the last appointment they got was convenient, compared to the national average of 92%.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Results for the National GP Patient Survey were well above local and national averages. For example, 95% of patients described the overall experience of their GP surgery as fairly good or very good (local average 88%, national average 85%).
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

We saw an area of outstanding practice:

• The practice was highly responsive to the needs of their patient group and the rural community in which they were based. People’s individual needs and preferences were central to the planning and delivery of tailored services. For example, given the lack of access to public transport the practice offered services to reduce the need for patients to travel to hospital. Staff had also set up initiatives to improve the physical and mental health and wellbeing of their patients, such as a weekly Health Fitness Club and a book swap scheme operated by patients.

The areas where the provider should make improvement are:

• Consider a review of written procedures within the main dispensary to ensure these describe the activities required to provide the remote dispensing service at the branch surgery and that there is a clear process for determining and reviewing which medicines should be prepared and taken to the branch surgery.
• Provide all staff with regular appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We first inspected Haverthwaite Surgery in February 2014. During the inspection we found that the practice was not compliant with Regulation 21 - requirements relating to workers. We served a compliance action. We re-inspected the practice on 20 August 2014 to assess the progress the practice had made towards achieving compliance.

In February 2014 we saw that there were gaps in the practice's recruitment policy with regards to the need to perform identity and disclosure and barring checks on staff. At this inspection (August 2014) we found that the recruitment policy had also been updated and now included guidance on the need to carry out Disclosure and Barring Service (DBS) checks and obtain evidence of staff’s identities.

We also found that all staff training had been reviewed and as part of each member of staff's development, training had been arranged to suit their individual needs. All mandatory training was now up to date.

When we visited Haverthwaite Surgery in February 2014 we found that the practice had achieved compliance with monitoring the quality of their service. On this inspection (August 2014) the practice manager was able to show us improvements they had made to their service which ensured continual compliance. This was seen a good practice and therefore included in this report.

We spoke with four patients who were visiting the practice on the day of our inspection. Each of the patients said they were happy with the doctor and that staff were helpful and respectful. Comments we received included, “Staff are friendly and the appointment system is good”, “I am very satisfied with the care I receive at this surgery”, “The practice is beautifully organised”.

We found the practice to be clean tidy and well maintained. The areas of the surgery used by patients had good disabled facilities, with all of the areas being easily accessed.

Consulting and treatment rooms were appropriately furnished and equipped and the design allowed for patients dignity and privacy to be maintained.

We saw that contracts and maintenance arrangements were in place to maintain the equipment and fabric of the premises.

Staff had appraisals which demonstrated that competence was assessed and that their professional development was supported. Two staff files we looked at did not contain all the information that is required by law to be kept and we have asked the provider to address this shortfall and to develop a recruitment policy. A range of staff training was provided however we did not see that staff had received fire training within the last 12 months, or recent training regarding infection control, chaperoning or health and safety.

The practice undertook audits to obtain feedback from patients regarding their experience