Irchester Surgery had been inspected previously on the following dates: -

14 December 2018 under the comprehensive inspection programme. The practice was rated as Good overall with a Requires Improvement for providing a responsive service and for all the population groups. A breach of legal requirements was found in relation to governance arrangements within the practice. A requirement notice was issued which required them to submit an action plan on how they were going to meet this requirement.

We carried out an announced focussed inspection at Irchester Surgery on 1 May 2019 as part of our inspection programme. As part of the Care Quality Commission annual regulatory review we inspected the domain areas of, effective, responsive and well led and utilised information from our previous inspection findings for the domain areas of safe and caring.

We based our judgement of the quality of care at this service 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.

We rated the practice as Good for providing Effective and Well-led services because we found

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We rated the practice as requires improvement for providing a responsive service and all population groups because:

• The findings of the national GP patient survey and CQC comments cards indicated that patients could not always access care and treatment in a timely way. The practice had taken steps to address this but at the time of our inspection there was insufficient data to measure the effectiveness. Dissatisfaction was still expressed in getting through to the practice by telephone and access to appointments.

The areas where the provider should make improvements are:

• Continue to monitor and improve patient satisfaction in respect of access to the service, in particular, the improvement of telephone access and appointments.
• Continue to monitor the training. development and clinical supervision of all staff.
• Continue to monitor confidentiality at the reception area.
• Consider carrying out an audit of minor surgery to ensure consent is being obtained and recorded.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Irchester Surgery on 14 December 2018.

We based our judgement of the quality of care at this service 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 with requires improvement for providing responsive services.

The rating for responsive affected the population groups so we rated all population groups overall as requires improvement.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice promoted the delivery of high-quality, person-centre care.

We rated the practice as requires improvement for providing responsive services overall including the population groups because:

• Patients were not able to access care and treatment in a timely way. While the practice had made improvements to their appointment system to make them more accessible, the 2018 National GP Patient Survey results and patient feedback indicated continued difficulties with the appointment system.
• The reception area was in a very confined space. While reception staff were trained to maintain confidentiality during telephone conversations, face to face conversations at the reception desk could be overheard. This was more relevant in relation to care navigation where patients were invited to share with the receptionist a brief outline of their illness to be navigated to the appropriate clinician and or service.

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.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Monitor the recently changed system to track the safety of blank prescription sheets.
• Monitor the revised systems for exception reporting, for diabetes and asthma.
• Develop information about the practice in written format which reflected the information available on the practice website.
• Develop detail and timescales for some priorities identified in the practice business plan.

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