Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkside surgery on 11 August 2016. The overall rating for the practice was good. The practice was rated as good in all domains except for the ‘safe’ domain which was rated as ‘requires improvement’. We found breaches of legal requirements(regulations) relating to the safe domain. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Parkside surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 11 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had an effective system in place to ensure that all medicines were in date.
• The practice had a a secure storage system for blank prescription forms and pads and a comprehensive, safe and effective tracking system in place.
• The practice had reviewed its staffing levels and skill mix to ensure that they met the needs of patients.
• Our previous inspection highlighted that the practice should continue to strengthen the systems in place for recalling and reviewing patients to improve patient outcomes. Action had been taken to address this and we observed a satisfactory system was in place for recalling patients who did not attend their scheduled health review. The outcome of these changes were reflected in improved data from the Quality and Outcomes Framework.
• The practice had identified a practice nurse to manage recalls for patients with a learning disability. This has resulted in an achievement of 87% attendance for a health review in the preceding 12 months.
• We also found that practice had recently engaged with its practice population and involved eight local schools in producing a new logo for the practice. They had involved practice staff and the patient participation group (PPG) in selecting the winners and had presented the winners with a prize. In addition, each participating school was provided with an art pack.

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 at Parkside Surgery on 11 August 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. Effective systems were in place for reporting, recording and analysing significant events. Learning was shared within the practice to improve the service.

• Risks to patients were assessed and mostly well managed; with the exception of disposal of out of date medicines and security of blank prescription forms.

• A recruitment drive had been initiated to increase clinical staff capacity with some success. For example, an advanced nurse practitioner was due to commence their role in September 2016 and a GP partner was due to start in November 2016.

• Following our inspection, we were informed the practice was not registering any new patients until January 2017 to enable the staff to focus on securing and sustaining improvements. This decision had been agreed with NHSE England and Southern Derbyshire clinical commissioning group.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had been supported with induction, training and appraisals to ensure they had the skills, knowledge and experience to deliver effective care and treatment.

• Nationally published data showed most patient outcomes were in line with or above local and national averages.

• Clinical audits demonstrated quality improvement.

• The practice team worked collaboratively with other health and social care professionals to understand and meet the range and complexity of people’s needs.

• Patients expressed a high level of satisfaction about the care and services they received. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Most patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities to treat patients and meet their needs.

• 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.

• There was a clear vision in place and staff were engaged in developing the objectives and how the practice was run.

• Staff felt supported by the management and were aware of the requirements of the duty of candour.

• The practice had a patient participation group which was actively involved in patient education, fundraising activities and improving the services in liaison with practice staff and other stakeholders.

We saw one area of outstanding practice:

The PPG was proactive in promoting patient education, prevention and early identification of health needs; in collaboration with other stakeholders. For example, the PPG had facilitated the following community events:

• A prostrate awareness evening was held at the local cricket club in January 2016, 21 people had attended. Guest speakers included a specialist eurology nurse from the local hospital, a representative from the North Nottinghamshire prostate cancer support group and a support worker from Maggie’s Trust (which provides free practical, emotional and social support to people with cancer and their family and friends positive feedback had been received from attendees).

• An oral cancer awareness day was held in September 2014 in conjunction with other PPG committee members from practices across the town, a dental team and members of Alfreton Cancer Research. Patients had access to free oral screening and pocket sized size cards were given out with the early signs of oral cancer printed on them.

The areas where the provider must make improvement are:

• Ensure effective systems are in place to check the expiry dates and stock levels of all medicines.

The areas where the provider should make improvement are:

• Strengthen the measures in place to maintain the security of prescription forms.

• Continue to review staffing levels for GPs to ensure sufficient cover is in place to meet patients’ needs.

• Continue to strengthen the systems in place for recalling and reviewing patients to improve patient outcomes. This includes performance indicators for some long term conditions such as diabetes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We spoke with six patients, two GPs, the nurse manager, three administration / reception staff and the practice manager during our visit. Patients told us they were satisfied with the care and treatment they received.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. Comments about the service included “Brilliant,” “Fantastic” and “Every member of staff always has time for you.” Patients told us about the regular check-ups they received. One patient said “Twice a year I have a diabetic check. They send me a letter and I phone to make an appointment.” Another told us “I see the nurse regularly as I am trying to loose weight.”

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

We saw that the provider did not have robust recruitment and selection procedures in place for newly recruited staff, and had not assessed the suitability of existing staff to work with patients and access confidential information.

The provider had systems in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.