Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Phoenix Surgery on 1 September 2016. Overall the practice is rated as good.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice was proactive in ensuring that all significant events were an opportunity for learning and improving.
• Risks to patients were assessed and well managed, with the exception of the safe management of medicines.
• 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The GP’s operated a system of personalised lists and 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.
• 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 provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

• Teenage mental health and behavioural issues had become a significant focus and the practice had initiated a service called Indigo. This provided accessible services to all young people irrespective of where they lived or which GP practice they were registered with. Indigo, offered support, advice and signposting for young people with mental health issues or needing advice on sexual health with positive outcomes.

• The practice demonstrated collaborative involvement as part of a GP led initiative with other organisations and the local community. For example, local schools and colleges, youth services and other GP practices. Working with a local trust the GP had secured funding for additional young people’s counsellors for “Cotswold Counsellors” and additional mental health provision within the school setting.

• Drop in clinics for young people were provided at the practice and led by two nurses with the necessary skills and experience. The practice also provided support and information for parents to help them discuss difficult issues, such as drugs, alcohol, eating disorders with their children.

• The practice had implemented a scheme called “Staywell” that supported patients over 75 years of age, that were identifiedto be frail, to remain healthy and continue independent living.A nurse practitioner was employed by the practice to lead on the scheme and provided a single point of access for patients and their families. There was collaborative working with other health professionals, social care and voluntary agencies was integral to providing services at the right time and the right place and ensured the service was tailored to meet the individual needs of each patient. The scheme had increased patient and family satisfaction with earlier identification and case management of vulnerable patients, reduced hospital admissions and improved social care support. The success of the scheme had led to the clinical commissioning group adopting this model and employing a team of eight nurses to deliver the service throughout the locality from October 2016.

The areas where the provider must make improvements are:

• Monitor the temperature of all areas where medicines are stored.
• Ensure all medicines and blank prescriptions are stored securely.
• Ensure all prescriptions for repeat medicines are signed by the prescriber before they are supplied to patients.
• Ensure policies relating to patient specific directions are followed.

The areas where the provider should make improvements are :

• Conduct a risk assessment of the dispensing process including lone-dispensing.
• Ensure that all fridges used to store medicines are appropriate and in line with national guidance.

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 Phoenix Surgery on 1 September 2016. We found that the practice required improvement for the provision of safe services because improvements were needed in the way the practice managed medicines, including emergency medicines and vaccines, as arrangements did not always keep patients safe. The overall rating for the practice was good.  The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Phoenix Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review 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 1 September 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

• Temperatures were being appropriately monitored in all areas where medicines were stored.
• A fridge that was suitable for storing medicines which measured minimum and maximum temperatures, in line with national guidance, had been purchased for the dispensary at Kemble.
• Policies relating to repeat prescribing had been updated and adhered to.
• Medicines and blank prescriptions were being stored securely.
• Policies relating to patient specific directives had been updated and adhered to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice