Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St George’s Surgery on 21 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 for the older people, children and families and young people, the working population, people in vulnerable circumstances and with long term conditions and people with mental health problems.

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.
• 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.
• 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 but not promoted clearly in the waiting areas.
• 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.
• 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.

We saw areas of outstanding practice:

• The practice provided general health advice including a sexual health clinic for young people. In addition a drop in clinic was available to young people registered with the practice where they could receive health advice or treatment including sexual health services.
• Patients were given a Gloucester Clinical Commissioning Group (CCG) ‘Online Care Plan’ card which they could share with services such as A&E to enable them to access their online care plan.
• The practice employed a practice nurse with a responsibility for three care/nursing homes who provides an annual health review of all residents registered with the practice in addition to reviews individual residents who may require for long term condition management.
• The Practice employed a Care Coordinator to manage the 226 patients on its most vulnerable patients list.

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

Importantly the provider should;

• Review how significant events and complaints are logged and ensure evidence is kept of how learning is made available to all staff in the practice.
• Review the system for storing and organising staff files, including recruitment, induction and training information.
• Ensure nursing staff receive formal training in regard of the Mental Capacity Act 2005
• Review how patient records are documented if the computer based record system fails.
• Ensure a log is maintained of completed audits to aid easier retrieval and monitoring of completed audit cycles.
• Review how complaints are logged and ensure the complaints policy is reviewed and made more accessible to patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection January 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at St George’s Surgery on 9 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice was keen to maintain staff well-being and had arranged various activities for staff.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Improve systems and processes to ensure blank prescriptions are tracked in the practice.
• Consider the level of safeguarding training required for the health care assistant.
• Improve records so that actions and learning from fire drills can be implemented.
• Identify and implement actions to improve uptake for reviews of long term conditions and the cervical screening programme.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice