Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Over Surgery on 24 November 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.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with, or above , others for most aspects of care.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt well supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Over Surgery has a practice population of approximately 4800 patients. We inspected the practice at 1 Dring’s Close, Over on 28 August 2014. During the initial inspection we spoke with three doctors, the practice manager, the practice pharmacist and a dispenser, two nursing staff, reception and administration staff. We also spoke with nine patients who were visiting the practice. For two weeks prior to the inspection, patients had completed comment cards giving their views on the service provided at the practice. We also looked at the systems, procedures and polices the practice had in place. The information we gathered supported our judgement on whether the practice was safe, effective, caring, responsive to patient’s needs and well-led.

During the inspection we looked to see how the practice met the needs of six specific population groups. There groups are; older people, people with long term conditions, mother, babies and young people, the working age population and those recently retired, people in vulnerable circumstances who may have poor access to care and people experiencing poor mental health.

We found that Over Surgery had procedures in place for the safeguarding of vulnerable adults and children. There was effective recording and analysis of significant events and incidents and the learning was shared with relevant staff to improve practice. There were reliable systems in place to manage medicines effectively.

The practice had systems in place to ensure that care and treatment was delivered to patients in line with the appropriate standards. The practice had a strong culture of clinical audit and used the results as part of a continuous improvement cycle. We also saw evidence of effective working with other members of the multidisciplinary team. Recruitment procedures required some improvements.

We spoke with nine patients; they all described staff at the practice as caring and helpful. The comment cards we received gave positive feedback and our observations on the day of the inspection were that patients visiting and telephoning the practice were treated appropriately by staff.

The practice was responsive to patients’ needs. Patients were able to access an appointment within a few days or more quickly if the matter was urgent. They also had the opportunity to give their views through a patient survey, a comments box or via members of the Patient Participation Group.

While aspects of the service were well led, further improvements were needed to some aspects of quality monitoring procedures. This was because some checks such as infection control and cleanliness were not formally monitored and recorded. It was not clear who had overall clinical leadership and this made it difficult to measure and monitor quality outcomes for patients.

The provider was in breach of regulations related to: requirements relating to workers, supporting staff and assessing and monitoring the quality of the service.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.