Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Doctors House- Marlow Medical Group on 15 April 2015. Overall the practice is rated as good.

We found the practice to be good for providing effective, caring, well-led and responsive services. It required improvement for providing safe services. It was good at providing services for all the population groups including older people; people with long term conditions; mothers, babies, children and young people; the working age populations and those recently retired; people in vulnerable circumstances 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.

• 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.
• 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 sought feedback from staff and patients, which it acted on.

Importantly the provider must:

• Ensure medicine management systems are reviewed and reflect national guidelines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with nine patients. Patients told us they were treated with respect and dignity. One patient described the reception staff as “Helpful, courteous and friendly. Other patient’s commented “Yes, been here for 15 years and they are great”, “The staff here are respectful” and “GPs (are) great the receptionists can be quite rude, and abrupt but they are very busy and under pressure.” In addition, feedback was sought from patients through a questionnaire. Patients were asked if they were treated with respect and dignity. Comments included “Yes, by making sure that I access the proper service and by using my proper name etc”, “Mostly” and “Yes, they listen to me and facilitate my request or give me the appropriate information.

During the visit we asked patients for feedback on the appointment system and appointment accessibility. We received mixed responses. One patient told us “I am always able to get an appointment on the day I call.” Another patient said “I have been with the practice for 20 years and getting an appointment has been generally easy.” A third patient told us “I can never get an appointment at the times it suits me.” However, all patients told us they were able to get an emergency appointment on the same day.

All the patients told us that they felt safe and confident with the care provided at the practice. Comments included “Most definitely, I feel very safe” and “I have been visiting this practice for over 12 years and safety has never been an issue.”

The provider was unable to demonstrate that sufficient recruitment checks had taken place to ensure staff were fit, appropriately qualified and able to undertake their role.

All the patients we spoke with told us they knew how to make complaint. One patient told us “Although I have not made a complaint, I am confident to go through the procedure should I need to.” Another patient commented “I have been with this surgery for twenty years and I have not had the need to complain.”

Letter from the Chief Inspector of General Practice

In April 2015 we found concerns related to the management of medicines during a comprehensive inspection of The Doctors House - Marlow Medical Group. Following the inspection the provider sent us an action plan detailing how they would improve medicine management systems ensuring they reflect national guidelines.

We carried out a desktop review of The Doctors House - Marlow Medical Group on 17 December 2015 to ensure these changes had been implemented and that the service was meeting regulations. Our previous inspection in April 2015 had found a breach of regulations relating to the safe delivery of services. The ratings for the practice have been updated to reflect our findings.

We found the practice had made improvements since our last inspection on 15 April 2015 and they were meeting the regulation relating to the management of medicines that had previously been breached.

Specifically the practice was operating safe systems in relation to the management of medicines. This included:

• Disseminating medicine alerts within the practice.

• Ensuring the temperatures in the practice refrigerators including dispensary were accurately recorded.

• Formal arrangements were in place and staff were aware how these operate to ensure the security of prescriptions in accordance with national guidance.

• A review and subsequent structure change of the management of dispensary at the Lane End branch surgery.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice