Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (Previous inspection 31 August 2016 – Good)

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 retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people living with dementia) - Good

We carried out an announced comprehensive inspection at Northfield Surgery on 15 January 2018 as part of our inspection programme.

We found one area of outstanding practice:

• Staff had liaised with the different types of  patient traveller groups and had developed Romany traveller and traveller patient participation groups which met every six months.  Staff were working with the groups to increase the awareness and importance of immunisations and NHS screening services and to provide feedback on the services the practice offered.

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.
• We saw staff involved and treated patients with compassion, kindness, dignity and respect. The practice had historically low patient satisfaction scores from the GP national patient survey. However, the provider had developed an action plan to address the issues.
• A new telephone system had been installed to improve telephone access to the practice. Care navigation had also been introduced and patients told us improvements had been seen.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider

should

make improvements are:

• Provide a chaperone training update for healthcare assistants.
• Consider developing a schedule for continuous quality improvement activity and include review dates.
• Review the process to respond to complaints to ensure that it includes keeping records of all investigations undertaken.

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 this practice on 5 January 2016. A breach of a legal requirement was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulation 16 Receiving and acting on complaints.

We undertook this focused inspection on 31 August 2016 to check that they had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Northfield Surgery on our website at www.cqc.org.uk.

Overall the practice is rated as Good.

Specifically,following the focused inspection we found the practice to be good for providing responsive services and for those people experiencing poor mental health (including people living with dementia).

• The practice had reviewed the care provided to patients with poor mental health. Of those with complex mental health problems 98% had an agreed care plan in place for the quality outcomes framework year 2015/16.
• The practice identified those patients with poor mental health who did not attend appointments and offered flexible appointment times or agreed weekly pre-arranged appointments with a named GP.
• The practice had reviewed it

  the complaint procedures and information was available and easy to understand. In addition to contacting the practice manager in person and writing to the practice, an email address had been created for patients to provide feedback to the practice online. Improvements were made to the quality of care as a result of complaints and concerns.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a follow up inspection on 5 January 2016 at Northfield Surgery as a result of the practice currently being in special measures due to non-compliance with the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 following our previous inspection in January and February 2015.

During this inspection in January 2016, we found the practice had made significant improvements since our last inspection in January and February 2015 and that they were meeting all of the three requirement notices which had previously been breached. The ratings for the practice have been updated to reflect our findings. However the provider is in breach of Health and Social Care Act 2008 (Regulated Activities)

Regulation 16 HSCA (RA) Regulations 2014 Receiving and acting on complaints.

The practice is rated as good overall for providing caring, safe, effective and well led service. It requires improvement for providing a responsive service.

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 although records of actions taken could be improved.
• Risks to patients were assessed and 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. The management of complaints could be improved to facilitate a timely response and provide details of investigations undertaken and the outcome in the response.
• Patients said they found it difficult to get through to the practice by telephone first thing in the morning to make an appointment. Urgent appointments filled up quickly.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a new leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

• Ensure when dealing with complaints the process follows the Parliamentary and Health Service Ombudsman ‘Principles of Good Complaint Handling’ guidance.

In addition the provider should:

• Include all of the investigation, analysis and actions taken as a result of significant event analysis on the investigation record.
• Review safeguarding policies to include the names of practice safeguarding leads.
• Keep a central log of actions taken following National Institute for Health and Care Excellence (NICE) guidance and patient safety alerts.
• Review the outcomes for patients with depression and mental health conditions and take action to improve this.

• Document and review the longer term improvement actions in a business plan to monitor their progress.

I confirm that this practice has improved sufficiently to be rated ‘Good’ overall. The practice will be removed from special measures.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

When we visited the service in August 2013 we found there were a number of areas of concern. At that time there was a shortage of GPs employed and patients had difficulty obtaining appointments. Safeguarding policies and procedures had not always been used appropriately. There were shortfalls in the repeat prescribing process. There were some gaps in the staff training plan and the staff appraisal system. Staff did not feel supported and there was a lack of clear management structure and communication. There were also shortfalls in the systems used to monitor the quality of the service.

As a result of that inspection we issued two warning notices and three compliance actions. These required the provider to make improvements in these areas in order to protect people.

We carried out this inspection to review the provider’s progress with these required improvements. We found that significant improvements had been made. However, there were some areas that required further development and we will continue to monitor the provider’s progress with this.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northfield Surgery on 28 January 2015 and 2 February 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe effective services and being well led. They were also inadequate for providing services for the six population groups. Improvements were also required for providing caring and responsive services.

Our key findings across all the areas we inspected were as follows:

• The majority of staff understand and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Systems, processes and practices are not always reliably implemented to keep people safe.
• Information about safety is recorded and monitored but it not robustly reviewed.
• Risks to patients are not always assessed and risks are not well managed.
• Data showed patient clinical outcomes are below average for the locality. Although some audits have been carried out, we saw no evidence audits are driving improvement in performance to improve patient outcomes.
• Urgent appointments were usually available on the day they were requested but filled up very quickly. Patients reported it was very difficult to get through the practice when phoning to make an appointment.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
• The practice had a number of policies and procedures to govern activity, but these are new and had not been fully implemented. The practice does not hold regular governance meetings.
• The practice has not proactively sought feedback from staff.
• Patients said they are treated with compassion, dignity and respect and they are mostly involved in their care and decisions about their treatment.
• Information about services and how to complain are available and easy to understand.

The areas where the provider must make improvements in the following areas. The practice must:

• Ensure there is an effective system for reporting and recording significant events.
• Ensure audits of practice are used to drive improvement in performance to improve

  patient outcomes.

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.

• Have a business continuity plan to deal with emergencies or major incidents, such as power failure, adverse weather or unplanned sickness, which may impact on the daily operation of the practice.
• Ensure all staff complete the practices mandatory training.
• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements
• Ensure fire evacuation drills are performed

In addition the provider should:

• Review the arrangements for privacy of patients in the reception area
• Review access arrangements for patients with respect to telephone access and appointments.
• Ensure there is a process in place to review locum work
• Ensure there is a process to track prescriptions through the practice
• Ensure patients are aware and can access information about chaperones

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice