Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Streets Corner Surgery on 31 October 2016. There are two surgery sites that form the practice; these consist of the main surgery at Lichfield Road and the branch surgery, Stonnall Surgery located at Main Street, Stonnall where the practice operates a dispensary. Systems and processes are shared across both sites. During the inspection we visited the main site at Lichfield Road and the branch, Stonnall Surgery. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Streets Corner Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 July 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 31 October 2016. During the inspection we only visited the main site at Lichfield Road. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice continues to be rated as good.

Our key findings were as follows:

• Arrangements to respond to emergencies and major incidents had been reviewed since our last inspection and additional arrangements were in place. The practice carried out risk assessments to mitigate any identified risks.

• Staff we spoke with explained that the failsafe system for managing cervical samples sent and received had been reviewed. We saw evidence of an effective system being operated. Unverified data provided by the practice showed an increase in the uptake of cervical screening and a significant reduction in exception reporting.

• The practice operated an effective system for monitoring and ensuring staff received appropriate training and continual professional development to enable them to fulfil the requirements’ of their role. We saw documentation which evidenced the completion of training.

• A system to monitor and review staff competencies’ during and after induction had been established. We saw that policies and procedures governed the induction process.

• Since our previous inspection, the practice continued exploring and establishing effective methods to identify carers in order to provide further support where needed. Data provided by the practice showed an increase in identified carers. Staff explained that 83 carers were invited to attend a six week programme run by a local organisation that provides self care management programmes called looking after me for carers. Data provided by the practice showed that 11% contacted the practice and showed an interest and 8% completed the six week programme.

• Evidence of joint working regarding the management patients in receipt of interventions for substance and alcohol dependency had improved since our previous inspection. We saw records of comprehensive joint care plans and completed health care reviews.

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 Streets Corner Surgery on 31 October 2016. Overall the practice is rated as good. There are two surgery sites that form the practice; these consist of the main surgery at Lichfield Road and the branch site Stonnall Surgery located at Main Street, Stonnall where the practice operated a dispensary. Systems and processes are shared across both sites. During the inspection we visited the main site at Lichfield Road and the branch Stonnall Surgery.

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 well managed in most areas. However, there were areas where risks were not effectively managed. For example, in the absence of some emergency medicines and equipment the practice did not complete a formal risk assessment.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Although we saw that staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment we saw some areas where training had not been completed since commencing employment.
• Although the practice had systems in place to encourage patients to engage in national screening programmes and record completed tests there were areas where the system was not effective and the practice were performing below local and national averages. However, to improve this the practice engaged in national awareness days to increase screening uptake and data provided by the practice showed an increase in uptake.
• Patients we spoke with during the inspection said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, data from the national GP patient survey showed that patients rated the practice below local and national averages for several aspects of care. The practice had reviewed this data and taken action to improve patient satisfaction.

• The practice had systems in place which alerted them if a patient was a carer and staff worked with the local carers association to explore effective ways of increasing their ability to identify carers.
• Information about practice based and external health care services was available and easy to understand. The practice worked under a shared care agreement with the local drug and alcohol service. Data provided by the practice showed a low number of completed care plans, medication and face-to-face reviews carried out in the last 12 months.

• 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.

• 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. In most areas governance arrangements supported the delivery of the strategy and good quality care.
• 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.

The areas where the provider must make improvement are:

• Ensure that risks are formally assessed and mitigated in the absence of specific emergency medicines and emergency equipment so that risks associated with emergency situations are effectively managed.
• Implement an effective failsafe system to manage cervical samples sent and received.

The areas where the provider should make improvement are:

• Establish an effective process for monitoring and ensuring staff have received appropriate training and continual professional development to enable them to fulfil the requirements’ of their role. Implement an effective system to monitor and review staff competencies’ during and after induction.

• Continue exploring and establishing effective methods to identify carers in order to provide further support where needed.

• Implement effective processes aimed at increasing the number of care plans, medication and face-to-face reviews carried out with patients in receipt of interventions for substance and alcohol dependency.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice