Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leap Valley Surgery on Tuesday 19 May 2015. Overall the practice is rated as good.

The practice provides a service at the Leap Valley Surgery in Downend and Abbotswood in Yate. We did not visit the Abbotswood surgery.

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 and any further training needs had been identified and planned.
• 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.
• The practice had good facilities and was 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.

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

Importantly the provider should:

• Ensure all significant events are recorded to maintain a record of the event and learning identified.
• Record prescription serial numbers when they are received in the practice so stocks can be audited.
• Ensure all prescription errors are recorded.
• Ensure the expiry date of the oxygen supply is recorded so it is not used when out of date.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating May 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Leap Valley Medical Centre and the branch surgery at Abbotswood on 15 and 16 November 2018 as part of our inspection programme.

At this inspection we found:

• There had been a significant change in the leadership at the practice since April 2017. The practice had recognised that sustainability and succession planning were needed to ensure the continued safe running of the practice. To facilitate this, they had recently merged with a local practice so that running costs, some administrative work and clinical teams could be used across the patch and ensure the continued level of service provision. This had involved a complete restructuring process which was on-going at the time of the inspection.
• We found that the ‘merging’ practice with an APMS contract which did not allow for a shared patient list, meant the two services were working with two EMIS patient record systems, and running parallel rather than as one service. This had an impact on the service as there was still duplication of work and the benefits of being one joined up service was limited.
• Practice leaders had established policies, procedures and activities to ensure safety but did not have systems in place to monitor and assure themselves that they were operating as intended. For example, learning from complaints was localised and not widely shared.
• Staff treated patients with compassion, kindness, dignity and respect.
• Patients feedback through the national GP patient survey (2018) indicated that although the appointment system was easy to use they experienced delays in being able to access routine care when they needed it.
• The provider had been responsive to the national GP patient survey (2017) and had introduced an urgent care team so that any patient contacting the practice for an urgent appointment had a telephone consultation with a clinician who then directed them to the most appropriate care.
• There was a focus on continuous learning and improvement within the organisation.

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.

The areas where the provider should make improvements are:

• Risk assess the emergency medicines which were not held by the practice.

• Update training for reception and administrative staff in respect of sepsis and provision of accessible information.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.