Letter from the Chief Inspector of General Practice

Hilary Cottage Surgery is a semi-rural GP dispensing practice providing primary care services to patients resident in Fairford and the surrounding villages Monday to Friday. The practice has a patient population of approximately 7,200 patients of which 24% are over 65 years of age.

We undertook a scheduled, announced inspection on 11 November 2014. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector and GP specialist advisor. Additional inspection team members were a practice manager specialist advisor.

Our key findings were as follows:

The overall rating for Hilary Cottage Surgery was good. Our key findings were as follows:

• Staff were caring and treated patients with kindness and respect.
• The practice worked with other health care providers to enable prompt treatment, reduce hospital admissions and enabled patients to be treated at home.
• Patients who had a ‘same day’ need were able to speak to or see a GP on the day they contacted the practice.
• Patients were cared for in an environment which was clean and reflected nationally recognised infection control practices.
• Patients were protected from the risks of unsafe medicine management procedures.
• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• The practice met nationally recognised quality standards for improving patient care and maintaining quality.
• GPs and nursing staff followed national clinical guidance.
• The practice had systems to identify, monitor and evaluate risks to patients.
• Patients were treated by suitably qualified staff.

We saw some outstanding practice:

• The practice had a system in place to assess the quality of the dispensing process and had signed up to the Dispensing Services Quality Scheme (which includes DRUMS – a dispensers’ review of the use of medicines). The practice had completed the criteria for successful achievement.

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

The provider should:

• Improve the completion of significant event records. Ensure all staff are enabled to attend meetings to discuss concerns, ideas and learning from events which affect their practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection November 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Hilary Cottage Surgery on 1 May 2018 as part of our inspection programme.

At this inspection we found:

• 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 was a focus on health and safety and daily assessments were carried out.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice had developed clinical templates which ensured clinicians had access to up to date best practice guidance and enabled them to promptly set tasks to ensure patients were monitored appropriately.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Feedback from patients and the patient participation group was positive regarding the quality of care experienced at the practice.
• There was a focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

The practice had received a certificate of accreditation for meeting the standards for the Workplace Well-being charter. Recognising the practices commitment to improving the well-being of staff work.

The areas where the provider should make improvements are:

• Review the systems for the management of correspondence and test results to ensure these are filed appropriately once they have been actioned.
• Improve the systems and processes so that near misses in the dispensary are recorded, emergency medicines are stored securely and actions are taken promptly when there are signs that the dispensary fridge temperature had operated outside of the normal range.

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