This practice is rated as Requires Improvement overall. (Not previously rated)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Oaklands Surgery on 26 and 27July 2018. This inspection was part of our inspection programme and to check that the new provider, Symphony Healthcare Services, was providing an appropriate service since they had assumed responsibility for the service 3 August 2017.

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 they provided. They ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• One of the practice staff has recently initiated patients accessing a new pre-diabetes prevention programme using some activity monitoring system/applications.
• There were good systems in place for reviews of patients and their medicines (polypharmacy – concurrent use of multiple medications by a patient) where they were taking four or more different medicines daily. 93% of patients in this situation had received an annual medicines review.
• There had been significant delays in the programme of annual reviews of patients with long term conditions, mental health needs and dementia, although improved recently they were still below the expected local and national targets.
• The practice offered access to a musculoskeletal specialist once a week to offer a quicker diagnosis and treatment for patients with minor muscular injuries and strains.
• Staff encouraged and supported patients to be involved in monitoring and managing their own health, for example through social prescribing schemes. Health coaches were providing a walking group every Monday and participating in the ‘CHAOS’ coffee mornings to listen and support patients.
• There were new policies and procedures and a system of governance which needed to have time to be fully implemented and embedded.

The areas where the provider must make improvements are:

• Ensure the necessary information is available regarding staff immunisation status in line with Public Health England(PHE) guidance.
• Ensure they monitor and address the gaps in clinical staff available required to maintain meeting the patients’ needs including patients with long term conditions, mental health and dementia.
• Ensure there are safe systems in place for fire safety, checks for safe equipment, including calibration, training for persons undertaking health and safety audits and risk assessments, for infection prevention and control and for chemicals used by the practice.
• Ensure medicines are stored safely.
• Ensure there is a system of safe storage and handling of prescription stationery.
• Ensure that patient confidential information at Yeovil Health Centre is kept securely and in line with General Data Protection Regulation (GDPR) 2018.
• Ensure there are governance systems for clinical oversight of the advance nurse practitioners and health care assistants.

The areas where the provider should make improvements are:

• Review and continue to monitor the progress to bring employment information up to date regarding staff transferred to the provider organisation such as training, skills and qualifications.
• Review and continue to monitor regular audits for health and safety.
• Review and develop an auditable system for managing safety alerts received at the practice.
• The practice should continue to proactively identify carers and respond to patient feedback regarding access to appointments.

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

Please refer to the detailed report and the evidence tables for further information