Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Primrose Surgery 1 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Primrose Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 December 2017 to confirm that the practice had undertaken their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 1 June 2017. 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:

• A considerable number of improvements had been made since the inspection in June 2017.There were now effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• All members of staff fully understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.There was consistency in incident reporting and reviews and investigations were being completed with the involvement of all members of staff.

• The members of staff we spoke to reported improved communication and a heightened awareness of surgery issues and patient information.

• Improved protocols had been introduced to identify and support carers.

• The arrangements for managing medicines in the practice were effective.

• All members of staff were trained to the appropriate and necessary levels.

• Leadership was stable and staff felt valued and involved.

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 Primrose Surgery on 1 June 2017. Overall the practice is rated as Requires Improvement.

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. However there was limited consistency and the system was not failsafe. Reviews and investigations were not consistently completed. The arrangements for managing medicines in the practice were not effective.

• Staff were trained to provide them with the skills and knowledge they needed to deliver effective care and treatment with the exception of safeguarding for one member of staff who was not trained to the appropriate level.
• Results from the national GP patient survey showed most patients felt they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. Complaints were responded to appropriately.
• Responses from patients we spoke to were mixed. Nine out of 14 patients we spoke with 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.
• The practice had been through a period of instability due to staff changes. Responses from staff were mixed about the current leadership structure which was still in its infancy.
• The practice proactively sought feedback from staff and patients, which it acted on and the provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvements are as follows :

• Ensure care and treatment is provided in a safe way to patients

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are as follows :

• Check that staff performing chaperone duties are recording an entry in the patient notes

• Establish a process to increase the number of carers identified and monitored.

• Maintain up to date information on the patient website

• Introduce a system to securely store and monitor the use of prescription pads
• Keep all emergency medicines in one place where they are easily accessible
• Introduce more frequent palliative care meetings
• Structure and monitor meeting minutes to ensure that actions are followed up

Professor Steve Field CBE FRCP FFPH FRCGP

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice