We carried out an announced comprehensive inspection at Shenley Green Surgery on 14 March 2019 as part of our inspection programme.

At the last inspection in December 2015 we rated the practice as good for providing safe, effective, caring, responsive and well-led services.

At this inspection, we found that the providers had mainly moved in line with changes within the healthcare economy and had shaped the practice to sustain delivery of high quality services in some areas. However, we found changes did not routinely support delivery of high quality services.

We based our judgement of the quality of care at this service 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 required improvement overall due to concerns in providing safe, caring, responsive and well led services. These requires improvement areas impacted on all population groups and so we have rated all population groups as requires improvement.

We rated the practice as requires improvement for providing safe, caring, responsive and well-led services because:

• Staff we spoke with demonstrated how to recognise and respond to safety concerns; however, records we viewed showed some clinical staff had completed safeguarding training appropriate to their role.
• The practice did not have a process for assessing the different responsibilities and activities of non-clinical staff to determine if they required a Disclosure and Baring Service (DBS) check.
• The practice learned and made improvements when things went wrong.
• The way the practice was led and managed mostly promoted the delivery of high-quality, person-centre care. However, oversight of the governance framework in areas, such as monitoring of training, recruitment checks and management of environmental risks were not carried out effectively.
• During our inspection, we saw that staff treated patients with kindness, respect and explained how they involved patients in decisions about their care.
• However, the practice scored below local and national averages in the 2018 national GP patient survey for questions relating to continuity of care and access. The practice were aware of this and were actively taking action to improve patient’s satisfaction.
• The practice implemented changes to the appointment system to improve patients access to care and treatment in a timely way. However; at the time of our inspection, the practice were unable to demonstrate whether patient satisfaction had improved.

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

• Patients received effective care and treatment that met their needs.
• The practice operated a programme of quality improvement activities and routinely reviewed the effectiveness and appropriateness of care provided. The practice monitored data such as Quality Outcomes Framework (QoF) performance and carried out actions to improve performance which were not in line with local or national averages.

The areas where the provider must make improvements are:

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training and professional development, to enable them to carry out the duties.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Continue taking action to improve areas where patient satisfaction is below local and national averages.
• Continue reviewing action plans and changes implemented as a result of quality improvement activities.
• Continue taking action to improve the uptake of national screening programmes such as cervical screening as well as improve areas where Quality Outcomes Framework performance were not in line with local and national averages.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shenley Green Surgery on 16 December 2015. 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 and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and generally well managed although we noted some exceptions where systems in place were not robust.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice was proactive in identifying and promoting additional support for patients health and wellbeing.
• Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients generally found it easy to make an appointment and were able to obtain urgent same day appointments when needed.
• 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 an area of outstanding practice:

• There was a strong focus on the physical and mental health and wellbeing of patients at the practice. The practice had been open to a variety of schemes which it offered from the premises. This included: mental health wellbeing to patients with long term conditions to help them cope with their condition (through the mental health charity Mind); supporting a self help group for patients with poor mental health; psychosexual counselling and access to health trainers who offered lifestyle advice and support. When the practice closed once a week the premises were used for an exercise class suitable for patients with long term conditions. The GPs joined in with the classes to give patients confidence when undertaking exercise.

The areas where the provider should make improvement are:

• Maintain robust systems for the changing of privacy curtains, storage of vaccines and other medicines requiring cold storage, and for monitoring staff training.

• Maintain a clear agenda and accurate records of meetings to minimise risk of follow up actions being missed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice