This practice is rated as Good overall (Previous rating February 2018 – Requires Improvement).

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an inspection at Park Parade Surgery on 15 February 2018 and rated the practice as requires improvement overall (requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services).

We carried out this announced comprehensive inspection on 24 October 2018. This inspection was carried out to check whether the provider had taken action to address shortfalls in relation to legal requirements which had been identified at our previous comprehensive inspection.

At this inspection we found:

• Action had been taken to address all areas of concern which had been identified at the previous inspection.
• Comprehensive business and succession plans had been developed which clearly set out the aims and objectives of the practice and how these would be achieved.
• 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 provided and ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patient feedback was very positive.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Take steps to ensure staff vaccinations and immunity levels are up to date.
• Review the fire risk assessment to confirm it remains relevant.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

This practice is rated as Requires Improvement overall. (Previous inspection March 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

The population groups are rated as requires improvement overall because we identified areas of concern in the safe and well led key questions, which have an impact on all population groups. There were, however, examples of good practice.

We carried out an announced comprehensive/focused inspection at Park Parade Surgery on 15 February 2018 as part our inspection programme.

At this inspection we found:

• The practice had some systems to keep patients safe and safeguarded from abuse.
• The practice had carried out a number of risk assessments but the systems for taking action following those assessments was not effective.
• 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.
• Recruitment checks on new staff were carried out but there were no processes in place to ensure staff’s ongoing registration with professional bodies.
• Quality Outcomes Framework (QOF) for 2016/17 showed the practice had achieved 99.2% of the points available to them for providing recommended treatments for the most commonly found clinical conditions.
• Some of the systems to ensure appropriate and safe handling of medicines were ineffective.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patient feedback was positive.
• Results from the National GP Patient Survey were well above local and national averages in nearly all areas.
• The practice organised and delivered services to meet patients’ needs. They took account of patient needs and preferences.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• There was a stable leadership team in place, but the practice did not have a defined vision or business plan which set out future priorities.
• Staff received training appropriate to their roles but some had not received an appraisal within the past 12 months.

The areas where the provider must make improvements are:

• Care and treatment must be provided in a safe way for service users; by ensuring the proper and safe management of medicines.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards.

The areas where the provider should make improvements are:

• Carry out a risk assessment to determine which emergency medicines are not suitable or necessary to stock within the practice.
• Take steps to improve access to the premises. The external door did not open automatically and there were no facilities for patients who needed assistance to summon support.
• Carry out a risk assessment for non-clinical staff who have not received a disclosure and barring (DBS) check.
• Take action to formally identify patients who are carers to ensure they are registered as such and are offered appropriate support.
• Carry out appraisals for all staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive announced inspection at Park Parade Surgery on 10 March 2015. Overall, the practice is rated as good. Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services. They were also good at providing services for the six key population groups we looked at during the inspection.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed;
• Risks to patients were assessed and well managed;
• The practice was clean and hygienic, and good infection control arrangements were in place;
• Patients’ needs were assessed and care was planned and delivered following best practice guidance;
• Patients said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment. Findings from the National GP Patient Survey of the practice, published in January 2015, indicated most patients had a high level of satisfaction with the care and treatment provided;

• Information about the services provided by the practice was available and easy to understand, as was information about how to raise a complaint;
• The practice had satisfactory facilities and was equipped to treat patients and meet their needs;
• There was a clear leadership structure and good governance arrangements. The practice actively sought feedback from patients.

We identified outstanding areas of practice:

• 6.05% of the practice population was made up of patients from the Bangladeshi community. This group of patients had been identified as having a higher incidence of diabetes, heart and respiratory disease. In response to these identified health needs, the practice had employed a Bangladeshi support worker to: liaise with patients; encourage their attendance at GP and hospital appointments, offer an interpreting service during consultations, and provide health education to the Bangladeshi community in collaboration with the practice health visitor;
• The practice scored very highly in some areas of the National GP Patient Survey, published in January 2015, when compared to others in their local Clinical Commissioning Group.  

However, there were areas of practice where the provider needs to make improvements. Importantly the provider should:

• Introduce a formal system for reviewing new clinical guidance;
• Obtain their own defibrillator, in line with current guidance and national standards;
• Ensure non-clinical staff carrying out chaperone duties undergo a Disclosure and Barring Service (DBS) check, or carry out a risk assessment to determine which staff roles do not require one.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice