Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Temple Cowley Medical Group on 22 February 2017. The overall rating for the practice was requires improvement, with ratings of requires improvement in the safe, responsive and well-led domains. The full comprehensive report from this inspection can be found by selecting the ‘all reports’ link for Temple Cowley Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 October 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 in February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There had been reviews of the practices’ systems and processes to improve governance and identify where improvements to service should be made.
• The practice had assessed and mitigated risks identified during the last CQC inspection.
• Medicines management and infection control processes had improved.
• Patient feedback regarding waiting times had improved.

The practice made changes to its services where we suggested it should consider improvements:

• The practice reviewed all patients who did not attend programmes for cancer screening where they were eligible to attend. The practice manager informed us that these patients were contacted to encourage them to attend screening. We reviewed data which indicated that within the Oxford locality of 25 practices the practice was ranked ninth for bowel cancer screening and fifth for cervical cancer screening for 25 to 49 year olds.
• The system for reviewing and acting on patient correspondence had improved and we saw that the workflow of clinical letters and correspondence was well managed. There were no significant backlogs of unreviewed patient correspondence on the day of inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Our previous announced comprehensive inspection in July 2016 found breaches of regulations relating to the effective delivery of service. The overall rating of the practice was good. Specifically, the practice was rated good for providing safe, caring, responsive and well-led services and require improvement for the provision of effective services.

After the inspection we had received information of concern from a whistle-blower in relation to patients being placed at risk. In response we carried out an unannounced focused inspection on 28 September 2016. We found breaches of regulations relating to the safe, effective and well-led delivery of services. The practice was not rated during the September 2016 focussed inspection.

Both inspection reports (July 2016 and September 2016) can be found by selecting the ‘all reports’ link for Temple Cowley Medical Group on our website at www.cqc.org.uk. Following both inspections, we received action plans which set out what actions the practice would take to achieve compliance.

We carried out an announced comprehensive inspection at Temple Cowley Medical Group on 22 February 2017. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

At this inspection, we found the practice had made some improvements. However, there were areas highlighted during the previous inspections where improvements are still required. Overall the practice is rated as requires improvement. Specifically, we found the practice to require improvement for the provision of safe, responsive and well led services. The practice was rated good for providing effective and caring services. Consequently we rated all population groups as requires improvement.

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

• The practice had demonstrated significant improvement in monitoring of document management system, referral management system and record keeping.
• The practice had carried out a comprehensive risk assessment of branch premises to assess suitability of the premises.
• The practice had taken steps to improve the waiting times for patients on the day of their appointment. However, it was too early to assess the positive impact of some changes made. The patients and staff we spoke with informed us that patients still had to wait a long time in the waiting area and patients said they were not satisfied with the poor availability of pre-bookable appointment with GPs.
• Risks to patients were assessed and managed. However, improvements were required in relation to infection control training, infection control measures and the management of blank prescription forms for use in printers which had not been monitored appropriately.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Data showed the practice had demonstrated improvements in patient’s outcomes.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Data from the national GP patient survey showed patient outcomes were varied in comparison to others in locality and the national average.
• Information about services and how to complain was available and easy to understand.
• There was a clear leadership structure. However, some staff said they would like the communication and interaction to be improved between the leadership and staff.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure and improve the management and tracking of blank prescription forms to use in printers, to ensure this is in accordance with national guidance.
• Ensure and improve the appointment booking system and waiting times for patients in relation to their allotted appointment time.
• Ensure all staff has received infection control training relevant to their role.

The areas where the provider should make improvements are:

• Consider completing a disability access audit of the main premises.
• Review and improve the systems in place regarding infection control measures.
• Consider information posters and leaflets are available in multi-languages and continue to encourage the uptake for the bowel screening programme and other services.
• Consider staff feedback to promote effective communication and provide the opportunity to engage in discussions about how to run and develop the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection of Temple Cowley Medical Group on 28 September 2016. The inspection was carried out because we had received information of concern from a whistle-blower in relation to patients being placed at risk. These concerns referred to the poor monitoring and management of patient correspondence in a timely manner. In addition there were concerns that referrals were not processed on time and consultation notes were not always documented. We were also informed that staff time keeping and waiting time in the waiting area were not monitored effectively. We found the service was not meeting fundamental standards and had breached regulations. Specifically, we found concerns and regulatory breaches relating to the safe care and treatment, and management and leadership of the practice.

The practice was not rated during this focussed inspection. Our previous announced comprehensive inspection in July 2016 found issues relating to the effective delivery of care and treatment and we asked the practice to make improvements. The practice was rated good for providing safe, caring, responsive and well-led services. This report should be read in conjunction with the full inspection report published on 21 September 2016.

Our key findings during this focussed inspection were as follows:

• Patients were placed at risk of harm because the practice had failed to act on patient correspondence in a timely manner. There was no system in place to ensure that patient correspondence across the practice managed appropriately.
• There were inconsistent arrangements in how risks were assessed and managed. For example, during the inspection we found risks relating to referral management system, failure to seek external specialist advice for complex cases and the practice did not carry out a formal written risk assessment to assess the suitability of the premises at the branch location.
• We noted inconsistent record keeping arrangements. For example, consultation notes were not always documented in patient records and the practice did not ensure to integrate dermatology photographs within the patient information management system.
• Time keeping and long waiting times in the waiting area were not monitored effectively.
• The practice had limited governance arrangements to enable assessment and monitoring of the service.
• Staff we spoke with informed us they felt supported in their role and the management was approachable and always took time to listen to all members of staff.

The areas where the provider must make improvements are:

• Further review, assess and monitor the governance arrangements in place to ensure the delivery of safe and effective services. For example, monitoring of document management system, referral management system and improve record keeping.
• Review and improve the systems in place to act on patient correspondence and referrals in a timely manner.
• Develop a more structured approach and seek specialist advice to ensure complex cases of patients experiencing poor mental health, and drug and alcohol related conditions are managed appropriately.
• Review and improve the systems in place to monitor staff time keeping effectively and waiting times for patients in relation to their allotted appointment time.
• Ensure risks related to the branch location are identified, documented and mitigated to assess suitability of the premises.

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 Temple Cowley Medical Group on 22 February 2017. The overall rating for the practice was requires improvement, with ratings of requires improvement in the safe, responsive and well-led domains. The full comprehensive report from this inspection can be found by selecting the ‘all reports’ link for Temple Cowley Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 October 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 in February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There had been reviews of the practices’ systems and processes to improve governance and identify where improvements to service should be made.
• The practice had assessed and mitigated risks identified during the last CQC inspection.
• Medicines management and infection control processes had improved.
• Patient feedback regarding waiting times had improved.

The practice made changes to its services where we suggested it should consider improvements:

• The practice reviewed all patients who did not attend programmes for cancer screening where they were eligible to attend. The practice manager informed us that these patients were contacted to encourage them to attend screening. We reviewed data which indicated that within the Oxford locality of 25 practices the practice was ranked ninth for bowel cancer screening and fifth for cervical cancer screening for 25 to 49 year olds.
• The system for reviewing and acting on patient correspondence had improved and we saw that the workflow of clinical letters and correspondence was well managed. There were no significant backlogs of unreviewed patient correspondence on the day of inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice