We carried out an announced comprehensive inspection at New Valley Practice on 4 January 2018. The overall rating for the practice was good, with safe rated as requires improvement. The full comprehensive report on the January 2018 inspection can be found by selecting the ‘all reports’ link for New Valley Practice on our website at .

This inspection was an announced focused inspection carried out on 2 August 2018 to confirm that the practice had carried out their plan to meet the legal requirement in relation to the breach in regulations that we identified in our previous inspection on 4 January 2018. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

The overall rating for the practice remains unchanged as good. However, the safe domain is now rated as good.

Our key findings were as follows:

Systems, processes and records had been implemented providing appropriate assessment, monitoring, management and mitigation of risks to the health and safety of patients who use services:

• The processes used for monitoring staff training and development was improved enabling effective monitoring of mandatory and role specific training could take place. For example, staff designated to carry out fire safety checks had received appropriate training for this role.
• The practice used a consultant for all human resources matters. The recruitment process was reviewed and a checklist put in place to prompt consistency with pre-employment checks being carried out.
• Installation checks had been carried out on new fire safety equipment. Ongoing monitoring checks were now being done regularly to ensure this equipment was in working order.
• Patient Specific Directions (PSDs) were used and now include full details of the medicine and dose to be given and were pre-authorised by the lead prescribing GP.
• Patient feedback was acted upon and an audit of patient waiting room times for an appointment was carried out.
• The practice had increased the number of carers identified as needing support from 98 in January 2018 to 129 in August 2018.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection report published September 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

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 carried out an announced comprehensive inspection at New Valley Practice on 4 January 2018. This was part of our scheduled 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 and to meet the needs of the patient population registered at the practice.

• Childhood immunisation uptake rates for the vaccines given were above standard. For children up to 2 years of age the practice rates were 94-96% which was above the national target percentage of 90%.

• 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.

• As a training practice, there was a strong focus on continuous learning and improvement at all levels of the organisation.

• New Valley practice resulted from the merger of Newcombes and Exe Valley practices in 2016.Organisational policies and procedures had been reviewed but some were not fully embedded across the organisation, these included: An effective system to monitor staff training and addressing gaps in a timely way. Adherence to the practice recruitment procedure in regard of pre-employment checks. Instigation of new fire safety procedures following the updating of equipment. Proactive authorisation of delegated duties to supply or administer a medicine directly to a patient.

We saw one area of outstanding practice:

There is a proactive approach to delivering care, which is accessible and promotes equality. For example, all patients with a learning disability have a designated GP and nurse skilled in total communication methods, have annual reviews in a place of their choosing and are able to see the learning disability consultant specialist at the familiar surroundings of the practice for appointments rather than having to travel to hospital.

The areas where the provider must make improvements are:

Ensure systems, processes and records are implemented or maintained to assess, monitor, manage and mitigate risks to the health and safety of patients who use services:

• The processes used for monitoring staff training and development were not effective in ensuring all staff had completed mandatory and role specific training in a timely way. For example, staff designated to carry out fire safety checks had not received appropriate training for this role.

• The recruitment process was not consistently followed in regard of pre-employment checks being carried out.

• Installation checks had not been carried out on new fire safety equipment and this was not followed up in a timely way with the company responsible for this. This resulted in alarm checks not being carried out since August 2017 because staff had not received appropriate training.

• Patient Specific Directions (PSDs) were used, however they did not always include full details of the medicine and dose to be given, or ensure that a pre-authorised list of patients was available.

The areas where the provider should make improvements are:

Review systems to ensure adherence of procedures and processes for fire safety, recruitment, authorisation of delegated duties to supply or administer a medicine directly to a patient and staff training.

Review systems to ensure there is accurate monitoring of training and skills of staff ensuring support is provided so they achieve the practice specified mandatory training in a timely way.

Audit patient waiting room times for an appointment to determine whether changes made since the GP Survey have improved patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice