Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North House Surgery on 17 February 2017. The overall rating for the practice was good, but was rated as requires improvement for providing safe services. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for North House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 February 2017. This report covers our findings in relation to those requirements.

The practice is rated as good overall including for providing safe services.

Our key findings were as follows:

• The practice had addressed the arrangements for medication reviews since the last inspection.

At our previous inspection in February 2017 we said the provider should make improvements in several areas. We saw at this inspection those that improvements had been made;

• The practice had improved their system for identifying carers, 1.8% of the practice population had been identified as carers compared to 0.5% at our previous inspection.

There were areas where the provider still needed to make improvements. At our previous inspection in February 2017 we said the practice did not have a strategy or a supporting business plan which outlined their vision and plans for the future. At this inspection we saw that this had not been yet been considered but arrangements had been made for a meeting regarding this in January 2018. We said that the infection control lead should have the appropriate training for this role. The lead nurse had recently left the practice and the new infection control lead was waiting to receive this training.

Therefore the provider should:

• Develop a written strategy and supporting business plan which outlines their vision and plans for the future.

• Ensure that appropriate training for the infection control lead is provided.

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 at North House Surgery on 17 February 2017. 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.
• Risks to patients were in the main assessed and well managed.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to get same day appointments.
• 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.
• The practice had a very active patient participation group (PPG), which worked with the practice to make improvements.

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

Importantly the provider must:

Have effective systems in place that ensures all required medicine reviews are undertaken.

The provider should:

• Improve the system for identifying carers.

• Develop a written strategy and supporting business plan which outlines their vision and plans for the future.

• Training should be provided for the infection control lead.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out this comprehensive inspection on 29 June 2015.

Overall, we rated this practice as requires improvement.

Specifically, we found the practice to require improvement for ensuring safe services, for being responsive and for being well led. The practice was rated as good for providing effective and caring services.

Our key findings were as follows:

• The practice was not able to evidence a good track record for safety. Lessons were not always learned and sufficient improvements were not always made when things went wrong.
• There were not reliable systems, processes and practices to make sure that risks to people were minimised, for example medicines were not managed in accordance with current guidance.
• Patients’ needs were assessed and care and treatment was delivered in line with current legislation, standards and evidence-based guidance.
• Patients’ care and treatment outcomes were monitored and compared with other similar services, and these outcomes were comparable to others.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice did not have sufficient GPs. Patients expressed dissatisfaction with the practice because they had difficulty obtaining timely appointments and could not get through to the practice on the telephone.
• Frequent staffing changes, especially amongst GP partners, had destabilised the practice structure, and meant that it was not always easy to identify who clinical leads were for specific areas.
• Although committed to their roles, staff did not feel they were sufficiently kept up to date with changes.

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

Importantly the provider must:

• Ensure systems are in place for the proper and safe management of medicines, particularly with respect to the monitoring of storage temperature and checking the use-by dates of refrigerated medicines.
• Explore all avenues of staffing and skill mix to ensure the practice is adequately staffed in the medium to long term.

The provider should:

• Ensure that learning from incidents and complaints is fully recorded and cascaded to other staff in order to maximise learning opportunities.
• Ensure staff receive in a timely fashion all required mandatory training updates.
• Ensure that formal governance arrangements are sufficient to fully assess and monitor risks and the quality of the service provision, including clinical and infection control audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice