This practice is rated as Good overall. (Previous rating 22nd August 2017 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Suttons Medical Group on 12 July 2018 to follow up on breaches of regulations identified at our inspection in July 2017. At our previous inspection in July 2017 we rated the practice requires improvement for providing safe and well led services.

At this inspection we found:

• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access when they needed it.
• The practice offered home visits and medication delivery service for those who could not access the practice.
• Since the last inspection the practice had employed a compliance manager to assist with the management of the two locations.
• The practice had implemented a system for safeguarding patients from abuse and improper treatment and worked with other agencies to ensure vulnerable patients were supported.
• A system had been put in place for monitoring high risk medication ensuring best guidance monitoring was complied with.
• The practice had put systems in place in relation to safety issues. For example fire and legionella.
• All clinical staff had access to NICE guidance during consultations and any new guidance was discussed as part of clinical team meetings.
• The practice had identified a high prevalence of diabetic patients and were actively improving treatment for these patients. The practice had become part of a diabetic network to support patients when moving between primary and secondary care. The practice also offered diabetic patients cognitive behavioural therapy as research had suggested this benefited newly diagnosed patients to manage their condition.

The areas where the provider should make improvements are:

• Review the clinical oversight and leadership at the branch surgery at Sutton Bridge
• Ensure systems for all significant events, complaints, dispensing errors and near misses include full investigations and any learning is shared with the practice team.
• Ensure patients are offered translation services if required to maintain confidential consultations.
• Improve dispensary standard operating procedures to include relevant information for processes.
• Continue completing quality improvement audits to implement systems which impact on patients.

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

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Long Sutton Medical Centre on 01 December 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, and people experiencing poor mental health.

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, with the exception of those relating to recruitment checks.
• 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 and easy to understand.
• 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.

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

In addition the provider should:

• Improve the arrangements for dispensing medicines. This includes reviewing the Standard Operating Procedures (SOPs) for medicines management and update these annually. Dispensing staff should also follow the clinical audit and incident reporting procedures; and make arrangements for dispensing assistants to receive regular knowledge and competency checks.

• Make arrangements for nurses to continue to access clinical supervision as already established by the practice.

• Arrange for policies and procedures to be regularly reviewed and updated including the whistleblowing policy, and child protection procedures

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 Sutton Medical Group on 25th and 26th July 2017.

Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Patients were at risk of harm because some systems and processes in place were not effective to keep them safe. For example, significant events and monitoring of patients on high risk medicines.

• There was a system in place for reporting and recording significant events but it was not consistent or clear. Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• The system in place to safeguard service users from abuse and improper treatment was not effective.

• There were some arrangements for identifying, recording and managing risks but not all had been well managed. For example, fire safety and legionella.

• Most of the medicines management practices in place kept patients safe.
• Feedback from people who use the service and stakeholders was positive. Fifty Two patients expressed high levels of satisfaction about all aspects of the care and treatment they received. The feedback from comments cards we reviewed said patients felt they received excellent care and were treated with care, compassion, dignity and respect.
• Data from the July 2017 national GP survey was also consistently high.
• Quality improvement had been carried out but we saw limited evidence that audits were driving improvements to patient outcomes.

• Patients we spoke with and comments cards we reviewed told us that the appointment systems were working well. They found it easy to make an appointment with a named GP and urgent appointments were available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a number of policies and procedures to govern activity.
• Some of the systems and processes in place were not established or operated effectively to ensure compliance with good governance.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients. In particular, fire safety, management of legionella and high risk medicines.

• Ensure patients are protected from abuse and improper treatment.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular, significant events, NICE guidance, referrals for two week waits, written information for carers, quality improvement, complaints, shared learning from significant events and complaints

In addition the provider should:

• Review some of the processes within the dispensaries. For example, record room ambient temperatures where medicines are stored, review the use of a radio in the dispensary at Sutton Bridge, risk assess the medicine deliver service, ensure only controlled medicines are kept in the CD cupboard.

• To strengthen the system for clinical audits and include more structure and a fuller analysis to ensure quality improvement.

• Complete the 2017 infection control audits for both medical centres.

• Ensure patients are aware that translation services are available.

• Review the system in place for patients who have a learning disability or experience mental health problems to ensure they are monitored and reviewed on a regular basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice