Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Palfrey Health Centre on 11 February 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 knew how to and understood the need to raise concerns and report incidents and near misses.

• Information about safety was recorded, monitored, appropriately reviewed and acted upon and risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following current evidence based guidance. Staff received training appropriate to their roles and further training needs were identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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 practice premises were acknowledged as a challenge to providing privacy in the reception area, but the staff were aware of this and acted accordingly and telephones were answered away from the reception desk.
• The waiting room was very compact and limited on space. Consulting rooms were also available on the first floor of the building and there was a lift available for patients to use, but any patients that had difficulty in using the lift or getting upstairs were seen in the ground floor consultation rooms.
• The provider was aware of and complied with the requirements of the Duty of Candour. The practice encouraged a culture of openness and honesty.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During the inspection process we spoke with six patients, five staff members, two GPs and the practice manager.

The patients we asked told us that staff at the surgery were polite. The patient satisfaction survey results indicated that some patients were unhappy with the current appointment process. However staff at the surgery told us that if necessary emergency appointments were available. Generally patients said they were happy with the care and treatment they received.

Staff must be appropriately supported, trained and supervised in delivering care and treatment to patients who used the service. We saw that staff had annual appraisals and training was available. The staff we spoke with said they were able to access training appropriate to their role.

The staff we spoke with were aware of their responsibility in safeguarding vulnerable adults and children from the risk of abuse. Staff had access to the necessary information should they need to raise a safeguarding concern.

Quality monitoring systems were in place at the practice. Patients were invited to comment on the quality of the service via a satisfaction survey. The surgery had a Patient Participation Group (PPG). PPGs are an effective way for patients and GP surgeries to work together to improve the service and to promote and improve the quality of the care.

At our last inspection in February 2016, we rated the practice as good in all domains and population groups.

We carried out an announced comprehensive inspection at Palfrey Health Centre on 27 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• The practice and the patient participation group with closely with the community to support educational events and healthy lifestyle initiatives.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. For example: development of clinical and non-clinical staff, participation in the latent TB screening project, ongoing clinical audits, providing training placements for medical students and working towards accreditation to become a teaching practice for GP registrars.

Whilst we found no breaches of regulations, the provider should:

• Formalise the system in place to ensure the competence to clinical staff working in advanced roles.
• Continue the actions currently being taken to improve the uptake of cervical screening.
• Continue to identify carers to enable this group of patients to access the care and support they need.
• Continue to monitor the GP survey results and identify areas where improvements can be made.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care