Letter from the Chief Inspector of General Practice

We carried out an announced focussed desk top inspection of Cosham Park Avenue Surgery on 9 October 2015. Overall the practice is rated as good.

Our previous inspection in January 2015 had found the practice was good overall. We found that the practice required improvement in the Safe domain due to breaches of regulations relating to safe delivery of services. The practice was good for Effective, Caring and Responsive and Well Led services.

We followed up on our inspection of January 2015 to check that action had been taken to meet the minimum standards. We have not revisited Cosham Park Surgery as part of this review because they were able to demonstrate that they were meeting the standards without the need for a visit.

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

• Risk assessments related to the Control of Substances Hazardous to Health (COSHH) were being carried out effectively and all cleaning procedures were robust enough to ensure control of infections in the practice.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

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 Portsdown Group Practice, Cosham Park Avenue Surgery 15 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services to older people, people with long term conditions, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health. It required improvement for providing safe services.

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, appropriately reviewed and addressed.

Risks to patients were assessed and well managed, with the exception of those relating to Legionella.

Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned for.

Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

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.

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.

We saw one area of outstanding practice.

The practice had a duty GP each day who answered the phones and was joined by two further GPs between 9.00am and 9:30am. The GPs triaged the calls dealing over the phone, giving general advice, booking urgent appointments or directing patients to the nurse practitioner.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

Ensure risk assessments related to the Control of Substances Hazardous to Health (COSHH) are carried out effectively and all cleaning procedures are robust enough to ensure control of infections in the practice.

The practice should :

Review the policy, recording and analysis in relation to comments and complaints.

Review disposal of sharps boxes and security of external waste bins.

Discuss clinical audits fully with relevant staff members.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Portsdown Group Practice on 4 and 5 December 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service is 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.

We have rated all population groups as good with the exception of working age people, which we rated as outstanding.

The working age people population group was rated as outstanding because:

• The practice had implemented a cervical screening improvement project had achieved a 46% increase in cervical screening uptake between January and October 2018.

We rated the practice as requires improvement for providing safe services because:

• There were shortfalls regarding the secure storage of external clinical waste.
• Potential risks to patient had not always been identified or managed.
• There were shortfalls regarding the use of Patient Group Directives (PGDs) to administer medicines, and the safe storage of prescription stationary and equipment.
• Safety incidents were not always identified and lessons learned was not always shared with all relevant staff.

We rated the practice as good for providing effective, caring, responsive and well-led services because:

• The practice undertook a project to improve outcomes for patients who had been indicated as potentially having a long-term condition or disease, but had not been diagnosed. The practice had subsequently increased the number of patients identified as having one of five long term conditions by more than 30% since 2017. Patients identified were invited to the practice for relevant health checks and their notes were coded to ensure they would continue to receive relevant treatment and support.
• The practice had implemented a childhood immunisation improvement project and had subsequently scored above the national target for all four quality indicators.
• The practice had implemented a learning disabilities team and had improved the uptake of annual health checks for patients with a learning disability from 59% in 2015/16 to 83% in 2017/18
• 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.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw one area of outstanding practice:

• The practice had developed long-term conditions teams; including a diabetes team, a respiratory team and a chronic heart disease team. Each team consisted of a lead GP, specialist trained nurses and administrators for long term conditions. The practice had seen an improvement in exception reporting data. For example, the practice had exception reported a total of 1,100 patients in 2016/17 compared to a total of 94 patients in 2017/18.

The area where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

• Lock and secure all external clinical waste bins.
• Review arrangements for the use of Patient Group Directions (PGDs) by individual health professionals working under the direction, to include signatures to confirm how they are used.
• Continue to review systems to monitor prescription stationary distribution throughout the practice, to include a record of serial numbers.
• Review arrangements to monitor and remove expired equipment.
• Continue to share learning from safety incidents with all relevant staff.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice