This practice is rated as Good overall.

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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – Good
• People with long-term conditions – Good
• Families, children and young people – Good
• Working age people (including those recently retired and students – Good
• People whose circumstances may make them vulnerable – Good
• People experiencing poor mental health (including people with dementia) - Good

We previously inspected the practice in November 2015 when we rated them good overall and for all the key questions, except for, “Are services safe”, which we rated as requires improvement. We carried out a focused follow-up inspection in March 2016 and rated them as Good for the provision of safe services.

The inspection of Market Lavington Surgery covered in this report was an announced comprehensive inspection on 1 May 2018. This inspection was carried out 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.
• 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.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was significantly above the national average of 84%.
• 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.
• The practice provides some services, such as a leg clinic in partnership with the other practices in the Devizes locality.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

There are areas where the provider should make improvements. The provider should:

• Review processes for encouraging and supporting staff to raise significant events when appropriate.
• Review internal systems for assessing pain to ensure it meets recognised guidance.
• Review processes for recording consent to ensure these meet recognised guidance.
• Review new protocol for dealing with uncollected prescriptions to ensure it iseffective.

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

Letter from the Chief Inspector of General Practice

When we visited Market Lavington Surgery on 19 November 2015 to carry out a comprehensive inspection, we found, the practice had breached a regulation relating to the safe delivery of services.

We found the practice required improvement for the provision of safe services because improvements were needed to ensure all relevant staff checks were undertaken. Overall the practice was rated as good.

Following the inspection the provider sent us an action plan that set out the change they would make to complete the relevant staff checks. Subsequently they supplied information to confirm they had completed the actions.

This focused inspection was undertaken to check the practice was meeting the regulation previously breached. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report of November 2015.

We found the practice had made improvements since our last inspection. The information we received enabled us to find the practice was meeting the regulation that it had previously breached.

Specifically Market Lavington Surgery was:

• Ensuring all staff that undertook chaperone duties had completed disclosure and barring service (DBS) checks. (These checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Market Lavington Surgery and the practice branch surgery at Urchfont, Village Hall on 19 November 2015.

This was the first inspection using the CQC comprehensive inspection programme. Overall the practice is rated as good. Market Lavington Surgery was committed to delivery of caring and responsive services for its patients.

We found the practice good for the delivery of effective, caring, responsive and well led services. However, the practice was found to require improvement for provision of safe services. All patient groups were rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• Some checks to identify whether a person has a criminal record, or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable, had not been completed.

We saw three areas of outstanding practice including:

• The practice had a comprehensive carers register to identify carers. They had won an award for their work with carers because they ensured priority and flexible access to appointments and an annual health check for this group of patients. There was close liaison with the local Wiltshire Carers trust to provide support, including benefit advice to all carers within the practice. The practice also offered carers a yearly educational event.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example patient feedback had been taken into account in the retention and redevelopment of the service offered at the Urchfont branch surgery.

• The practice engaged with the local school to offer smoking cessation and education service.

However, there was an area of practice where the practice needs to make improvement.

The provider must:

• Complete DBS checks for staff undertaking chaperone duties.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice