We carried out an announced comprehensive inspection at High Street Surgery on 27 June 2018. The overall rating for the practice was good with requires improvement for providing well-led services. The full comprehensive report on the 27 June 2018 inspection can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 December 2018 to confirm that the practice had made the recommended improvements that we identified in our previous inspection on 27 June 2018. This report covers our findings in relation to those improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• There were clear responsibilities, roles and systems of accountability to support good governance and management.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The area where the provider should make improvement is:

• Continue to review and ensure improvement to the National GP Patient Survey results, including access to the practice by telephone and appointment waiting times.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief 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 carried out an announced comprehensive inspection at High Street Surgery on 25 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 and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed with the exception of infection control procedures. Infection control audits had been completed however, we noted there were some areas of infection control lacking. For example, there was a carpet on the floor of the treatment room used for procedures such as blood taking and patient wound dressings. Some of the sinks did not have elbow taps. There were also sharps bins that did not have a recorded date when assembled.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide 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.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had facilities suitable for patients with disabilities that included allocated parking spaces, a ramp at the rear entrance and access enabled toilets.
• 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.
• Patients who required support to live healthier lives were signposted to the relevant service. For example, children identified as overweight were referred to a local group called Movers and Munchers that encouraged learning about food and cooking combined with activities to lose weight.
• The practice had a carers lead and had identified approximately 3% of their patients as carers.

The area where the provider must make improvement is:

• Ensure action is taken to address identified concerns in relation to infection prevention and control.

The area where the provider should make improvement is:

• Continue to monitor and ensure improvement to national patient survey results, for example access to the practice by phone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously inspected High Street Surgery in January 2014 and found that the practice was not compliant with four essential standards. This was in relation to the way services for patients were planned, the use of emergency equipment, the cleanliness of the practice, the management of medicines and the way that the quality of service was monitored. We required the provider to make improvements.

We inspected the practice again on 17 July and found that those improvements had been made.

The practice had begun to use information from the Quality Outcomes Framework (QOF), to plan their services in a more cost effective way. The QOF is the national data management tool generated from patients’ records that provides performance information about primary medical services and facilitates their funding. Automated external defibrillators (AED) had been purchased and staff trained in their use. Equipment, including the AEDs and other emergency equipment was monitored regularly to ensure it was not out of date.

Staff had received additional training in infection control and there were effective cleaning systems in place. Outstanding actions from the practice infection control audit had been attended to.

Controlled drugs were no longer held at the practice. Temperature sensitive medicines and vaccines were stored appropriately and checked to ensure they were safe to use.

The practice had begun to use a computerised document and policy management system that ensured staff were always aware of current guidance and procedures. The practice had implemented a range of quality monitoring systems, including a procedure for checking test results in the absence of the requesting doctor.

We carried out an inspection of High Street Surgery and the branch practice, Abbey Surgery, on the same day. This report provides information for both the main and branch practices.

Patients' privacy, dignity and independence were respected. One patient told us, “I can get an appointment when I need one. I know I have to ring up the practice first thing and they can find me an appointment.”

Feedback from most of the patients was positive. One patient told us, “My care’s been ok here. The doctors have been good.”

We found the main and branch practices did not have a defibrillator. Staff did not have access to appropriate emergency equipment at both the main and the branch practice.

The practice had not ensured patients and staff were protected from the risk of infection. Medicines were not kept safely. We found that controlled drugs at both practices were not stored correctly.

We saw some records of training courses which staff had attended, including chaperoning patients and safeguarding children. We found that none of the three staff whose files we checked had completed appraisals annually or supervisions regularly but the practice manager planned to start staff supervisions from February 2014.

We spoke with four staff who were positive about the practice team. One staff member said, “The whole team works together really well.”

The practice was not monitoring and assessing the quality of services provided in a regular manner.

We checked if audits and risk assessments had been completed for infection control, medicines, staff training and fire. We found some audits and risk assessments had been completed but these were not carried out regularly.