Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Crest Family Practice on 31 March 2015. Overall the practice is rated as good. We did not inspect their branch surgery in St Johns Lane Health Centre located at Bedminster.

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 patients 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 (including people with dementia).

Our key findings 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.
• 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 GP or nurse and that there was continuity of care. Urgent appointments were available the same day and 97% of patients said they had confidence and trust in the last GP they saw or spoke with.
• The practice was purpose built with 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 sought feedback from staff and patients, which it acted on.

We saw there were areas of practice where the provider needs to make improvements. Importantly, the provider should:

• Review their system for recording actions taken following significant event investigations.
• Review their policies to ensure clear processes are available for staff for example, to manage cold chain procedures.
• Review their policies to ensure clear recruitment processes are stated and followed for all new employees, personal staff safety is maintained and written patient consent are gained for minor surgery.
• Review their process for how verbal or informal complaints are managed.
• Review risks in regard of staff safety.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating March 2015 – Good)

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? - Good

We carried out an announced inspection at The Crest Family Practice on 28 June 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

• The practice worked with five other practices Bristol Community Health (BCH) on a community based approach to the management of leg ulcers. This meant that all patients with leg ulcers were treated in a community clinic. As a result, there have been improved outcomes for patients, both clinically and socially.

The areas where the provider should make improvements are:

• Monitor and improve higher than average quality outcome framework exception reporting.
• Continue to monitor the improvements made to the infection prevention and control policy, to ensure they are effective.
• Consider improving the system for identifying stock levels of emergencies medicines held in clinical areas.
• Continue to monitor the improvements made to monitoring safety alerts, to ensure they are effective.
• Continue to monitor the effectiveness of the newly implemented information leaflet provided to patients following minor surgery.

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.