We carried out an announced comprehensive inspection at Nettlebed Surgery on 17 February 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. However, there was not a process for documenting that action plans had been carried out.
• Risks to patients were not always assessed and well managed in relation to staff training, storage of clinical waste, medicines management, and legionella.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff delivered effective care and treatment.
• The practice indicated that 41% of patients aged 15 to 25 years had been screened for chlamydia in the past 12 months and 59% of people over 60 years have had bowel cancer screening. This was in line with CCG averages (59%) and national averages (58%) for bowel cancer screening.
• 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.
• The practice provided excellent support and information for carers and raised awareness of sources of carer support available.
• 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.

We saw one area of outstanding practice:

• The practice provided excellent support and information for carers and raised awareness of sources of carer support available. A Carer Awareness day was held at the practice annually. Scores on the National GP patient survey 2015 and 2016 were strongly positive and consistently higher than local and national averages and reflected high levels of patient satisfaction with care.

The areas where the provider must make improvements are:

• Ensure that sharps are disposed of in the correct colour coded bags and bins.
• Develop a comprehensive risk assessment and plan for the process of dispensing and delivering medicines to locations other than the practice for patient collection.
• Carry out a legionella risk assessment and plan.
• Ensure that all staff have carried out appropriate training in infection control, and equality and diversity and that all training is recorded.

The areas where the provider should make improvement are:

• Implement a process for documenting that action plans for significant events have been carried out.

Professor Steve Field

CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In February 2016, during our previous comprehensive inspection of Nettlebed Surgery, we found issues relating to the safe delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make further improvements; in order to ensure that sharps are disposed of in the correct colour coded bags and bins. (Sharps refers to a medical term used for devices with sharp points or edges that can puncture the skin, for example needles).

We also found that the practice did not have a comprehensive risk assessment for the process of dispensing and delivering medicines to locations other than the practice. Furthermore, the practice had not carried out a legionella risk assessment and plan. The practice also needed to ensure that all staff had carried out appropriate training in infection control, and equality and diversity, and that all training was recorded. Finally at our previous inspection, we also found that the practice needed to implement a process for documenting that action plans for significant events have been carried out.

Following the last inspection, the practice was rated as requiring improvement in safe services, and good for effective, caring, responsive and well led services. The practice had an overall rating of good.

We carried out a desk based inspection in November 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of letters to patients, a copy of a training matrix, evidence of their legionella risk assessment, and minutes from a significant events meeting, to demonstrate the range of improvements they had made, since our last visit. The practice also further supplied a chart outlining the areas the practice had attempted to improve. We found the practice had made improvements since our last inspection in February 2016.

At this inspection we found that:

• The practice advised us that appropriate steps had been taken to ensure, that all sharps were disposed of in the correct colour coded bags and bins.

• Following the last inspection, the practice had ceased the delivery of all medications to rural collection points.

• The practice had produced a summary of their legionella risk assessment, and had provided evidence that this was now being followed.

• The practice had a training matrix detailing the various courses staff had undertaken. The training matrix included infection control and equality and diversity training for all three GPs.

• The practice had supplied minutes from a significant event meeting to demonstrate the learning in place for such events.

The areas where the provider should make improvements are:

• Continue to improve the systems used to document training and significant events.

• Ensure all members of staff receive equality and diversity training and clinical staff receive infection control training.

Following this desk based inspection we have rated the practice as good for providing safe services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 17 February 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In February 2016, during our previous comprehensive inspection of Nettlebed Surgery, we found issues relating to the safe delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make further improvements; in order to ensure that sharps are disposed of in the correct colour coded bags and bins. (Sharps refers to a medical term used for devices with sharp points or edges that can puncture the skin, for example needles).

We also found that the practice did not have a comprehensive risk assessment for the process of dispensing and delivering medicines to locations other than the practice. Furthermore, the practice had not carried out a legionella risk assessment and plan. The practice also needed to ensure that all staff had carried out appropriate training in infection control, and equality and diversity, and that all training was recorded. Finally at our previous inspection, we also found that the practice needed to implement a process for documenting that action plans for significant events have been carried out.

Following the last inspection, the practice was rated as requiring improvement in safe services, and good for effective, caring, responsive and well led services. The practice had an overall rating of good.

We carried out a desk based inspection in November 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of letters to patients, a copy of a training matrix, evidence of their legionella risk assessment, and minutes from a significant events meeting, to demonstrate the range of improvements they had made, since our last visit. The practice also further supplied a chart outlining the areas the practice had attempted to improve. We found the practice had made improvements since our last inspection in February 2016.

At this inspection we found that:

• The practice advised us that appropriate steps had been taken to ensure, that all sharps were disposed of in the correct colour coded bags and bins.

• Following the last inspection, the practice had ceased the delivery of all medications to rural collection points.

• The practice had produced a summary of their legionella risk assessment, and had provided evidence that this was now being followed.

• The practice had a training matrix detailing the various courses staff had undertaken. The training matrix included infection control and equality and diversity training for all three GPs.

• The practice had supplied minutes from a significant event meeting to demonstrate the learning in place for such events.

The areas where the provider should make improvements are:

• Continue to improve the systems used to document training and significant events.

• Ensure all members of staff receive equality and diversity training and clinical staff receive infection control training.

Following this desk based inspection we have rated the practice as good for providing safe services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 17 February 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice