Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sunray Surgery on 7 July 2016. 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 a system in place for reporting and recording significant events; however, this was in need of review to ensure it was robust.
• Overall, risks to patients and staff were assessed and well managed; however, at the time of the inspection risk assessments and risk mitigation plans were not always recorded.

• 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; however, there was no process in place to ensure that nursing staff received the update training they needed at the correct intervals.
• 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 on request and easy to understand. Complaints were responded to quickly; however, patients did not always receive a written response to their complaint and verbal complaints were not always recorded. 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. 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 one area of outstanding practice:

• The practice had a high proportion of patients who did not have English as their first language. The majority of these patients were Tamil speakers, some of whom were refugees or asylum seekers. The practice kept registers of these patients and had recorded 191 refugees/asylum seekers and 1106 patients with poor English language skills. In order to engage with these patients, signs in the practice were written in both English and Tamil, and the practice had produced several information leaflets in Tamil. Patients were also able to consult with GPs in Tamil (three of the five GPs at the practice spoke the language, as did a member of reception staff and the practice nurse). We were told by the practice that patients who were Tamil-speakers often remained registered with them when they moved away from the area, as these patients preferred to be able to consult with a doctor in their native language; the practice allowed these patients to remain registered and for this reason did not operate a strict patient area boundary; this was confirmed by some of the patients who provided feedback via the CQC comments cards.

The areas where the provider should make improvement are:

• They should review their process for recording and reporting significant events to ensure that all staff are aware of the threshold for recording a significant event and that all staff are involved in the process.
• They should ensure that action is taken to manage risks to patients and staff and that this is recorded. In particular, they should consider whether fire drills should be carried-out whilst patients are on the premises; they should also review their process for checking that prescriptions are collected by patients.
• They should ensure that information about bereavement support is available to all patients.
• They should review arrangements to identify carers so their needs can be identified and met.
• They should review the way that they handle complaints to ensure that patients receive a written response, which includes details of the Health Service Ombudsman. They should also ensure that verbal complaints are recorded.
• They should ensure that they have a consistent approach to recording care plans and that a copy of each care plan is saved to the relevant patient’s records.
• They should ensure that records and plans are in place to enable the smooth running of the practice should a key member of staff be absent.
• They should review their nursing provision to ensure that staff have sufficient protected time to carry-out areas of their role such as infection control and administration, and that nurses are receiving update training at the correct intervals.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice