Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Summerfield GP and Urgent Care Centre on 15 February 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for Summerfield GP and Urgent Care Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 December 2017 to confirm that the practice had carried out their plan to make improvements since our previous inspection in February 2017.

Overall the practice is now rated as good.

Our key findings were as follows:

• The service had made significant progress in relation to the concerns raised at our previous inspection in February 2017.
• There were effective systems in place to ensure appropriate action was taken in response to uncollected prescriptions.
• Audits undertaken demonstrated appropriate antibiotic prescribing in line with local guidance.
• There was significant improvement in relation to patient outcome data. Performance for most long term conditions was comparable to CCG and national averages. Action had been taken to improve patient outcomes for long term conditions which were previously noted as outliers, including diabetes and hypertension.
• The practice had taken action to improve uptake of childhood immunisations and national cancer screening programmes. There was limited new data available to demonstrate the impact of this at the time of this inspection however data provided by the practice was positive.
• The latest available national patient survey data (published July 2017) demonstrated improved patient satisfaction with the service. This was supported by feedback from the friends and family test data and CQC comment cards. For example, between July 2016 and July 2017 the proportion of patients who described the overall experience of the GP practice as good had improved from 62% to 80% and was in line with the CCG and national averages. There was evidence of action being taken to further improve satisfaction scores.
• The provider had been proactive in identifying and supporting carers. The number of carers had dramatically increased and a range of support including carers’ workshops made available. There had been positive feedback from carers on this.
• The provider had strengthened processes to ensure patients were not at risk during long waits for the urgent care centre. Reception staff had received formalised training to identify patients requiring urgent assessment and processes were in place for ensuring an appropriate clinical response. There was also evidence that average waiting times had significantly been reduced.

The areas where the provider should make improvement are:

• Continue to review the impact of actions taken to improve patient outcomes, uptake of childhood immunisations and national screening programmes to ensure improvements are sustained.

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 Summerfield GP and Urgent Care Centre on 15 February 2017. Overall the practice is rated as requires improvement.

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 generally assessed and well managed to keep patients safe. The one exception being the management of uncollected prescriptions. This issue was immediately addressed by the provider.
• There was a strong focus on learning and improvement and an open culture to support this.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Performance data showed mixed outcomes for patients with long term conditions and comparatively lower uptake of national cancer screening programmes and some childhood immunisations. However, there had been improvements made in relation to diabetes outcomes. It was also recognised the complexity and challenges of engaging with the population served.
• Patient satisfaction data was mixed and results from the national GP patient survey showed scores that were lower than CCG and national averages. However, feedback from the CQC comment cards were positive and we saw evidence and examples that patient feedback was listened and responded to.
• 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.
• The service was open seven days a week with on the day urgent appointments available when necessary. At the time of the inspection we noted routine appointments were available within two days. However the national GP patient survey showed patients found it difficult to make an appointment. The provider demonstrated actions taken to address this which included continual monitoring of access and patient satisfaction. Patients had indicated improvements in access following the installation of a new telephone system.
• The provider had good facilities and was well equipped to treat patients and meet their needs. This included support for the high proportion of patients whose first language was not English.
• 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.

The areas where the provider should make improvement are:

• Identify further ways in which patient satisfaction might be improved.
• Review and implement ways in which the identification of carers might be improved so that they may receive support.
• Review the urgent care system to identify ways in which patients may be assessed during long waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously inspected Summerfield Urgent Care Centre on 14th February 2013. At the time we found that patient satisfaction surveys did not identify whether the information related to the GP practice or to the urgent care centre. We could not find evidence to demonstrate that action had been taken where comments or complaints were made. We also saw that audits of medication and emergency equipment were not up to date. We judged that this had a minor impact on patients who used the service. We set compliance actions and told the provider to improve. The provider sent us an action plan following our visit which recorded the actions taken to address the issues raised.

We gave short notice of this inspection so that any disruption to people's care and treatment were minimised. We spoke with three members of staff. We found that the provider had made the necessary improvements.

We saw copies of recent satisfaction surveys. People were required to identify whether they had visited the GP practice or the urgent care centre.

We saw details of action taken to address complaints or issues raised in satisfaction surveys.

We looked at records to demonstrate that medication stock was checked. We saw that audits of these records were completed.

We looked at records to demonstrate that emergency medical equipment was checked on a daily basis to ensure that it was available for use in good working order.

During our visit to Summerfield GP and Urgent Care Centre we reviewed the walk in/urgent care service, we did not review the general practice. We spoke with six people who used the service and five staff.

The people we spoke with were satisfied with the care and treatment they had received through the walk in service. Three of the people we spoke with told us that the length of wait could sometimes be an issue but they were usually seen within the hour. People told us, "Staff are always very polite” and “I prefer to use the urgent care centre as it is quicker and fits in with my working hours.”

People's dignity and diversity were respected. All consultations were carried out in private and the facilities were suitable for people with additional mobility needs.

Systems were in place to ensure that people’s health needs were assessed and met. Appropriate follow up actions were taken to ensure other professionals involved in people’s care were kept informed of the treatment given meaning people were protected from receiving inappropriate treatments.

People were cared for by appropriately qualified staff that had been recruited through a robust recruitment process There were procedures in place to ensure that staff were aware of the actions to be taken to protect people. This ensured that people were safeguarded from harm.

Monitoring of the quality of the service could be improved to ensure that people received a good service that met their needs safely.