This practice is rated as Good overall. (Previous inspection February 2016 – Good)

The key questions 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 comprehensive inspection at The Dower House on 13 June 2018. This was as part of our inspection programme.

At this inspection we found:

• The practice had 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.

The areas where the provider should make improvements are:

• There was a system for recording and acting on safety alerts. The practice should improve the recording of the actions taken when they received the alerts.
• Continue to improve telephone access for patients.
• Monitor and work to increase the results of some childhood immunisation indicators.
• Continue to improve the number of eligible patients who were screened adequately for cervical cancer.

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 Dower House Surgery on 11 February 2016. The practice was rated as requires improvement for the safe domain and good for effective, caring, responsive and well led domains. Overall the practice was rated as good.

During that inspection we found that the practice was not compliant with the legislation in relation to safeguarding training for all staff. We found that not all nursing staff had up to date safeguarding training that was relevant and at a suitable level for their role.

During our last inspection we reviewed safety records, incident reports, national patient safety alerts and minutes of meetings. We found that some lessons had been shared to make sure action was taken to improve safety in the practice but not always; in particular, when there were unintended or unexpected safety incidents, we found that lessons learned were not always communicated widely enough to support improvement.

The report setting out the findings of the comprehensive inspection was published in April 2016. Following the inspection we received an action plan from the practice detailing how they would improve on the areas of concern.

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

The areas where the provider must make improvements are:

         • Ensure all nursing staff had received up to date safeguarding training.

We carried out a desk based inspection of The Dower House on 5 September 2016. The purpose of this inspection was

to follow up the requirements from the last inspection and

to assess if the practice had implemented the changes necessary to ensure patients who used the service were protected against the risks associated with the report published in April 2016.

Overall the practice is now rated as good.

We found the practice had made the required improvements since our last inspection on 11 February 2016. Following this desk based inspection we rated the practice as good for providing safe services. The overall rating for the practice remains good. For this reason we have only rated the location for the domain of safe. This report should be read in conjunction with the full inspection report of 11 February 2016. A copy of this report can be found on our website at www.cqc.org.uk.

At this inspection we found action had been taken by the provider, evidence supplied by them showed that;

       • All nurses had completed level 3 safeguarding children training.

       • Systems were now in place to ensure all staff had undertaken refresher training at appropriate intervals

• The practice reviewed their Significant Events Analysis Process to effectively communicate lessons learnt to all relevant staff.

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 Dower House Surgery on 11 February 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• When there were unintended or unexpected safety incidents, reviews and investigations were not always thorough enough and lessons learned were not communicated widely enough to support improvement.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe.

The areas where the provider must make improvement are:

• Ensure all nursing staff had received up to date safeguarding training.

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 Dower House Surgery on 10 March 2015.

Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and well led services. It also required improvement for providing services for older people, people with long term conditions, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health. It was rated good for caring, responsive and effective services.

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 and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks, fire and electrical safety and infection control.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles but specialist role training needs had neither been identified or planned for.
• 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.
• 93% of respondents to a national patient survey said their overall experience of the practice was good
• Dower House Surgery is also a training practice for doctors training to be GPs and medical students.
• The practice also used the Quality and Outcomes Framework (QOF) to measure their performance. The QOF data for this practice showed it in 2013/14 they had met 99.1% of the outcomes. This was higher than the national average for GP practices.

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

Importantly, the provider must:

• Carry out risk assessments for health and safety, legionella and fire safety.
• Identify, manage, monitor and audit effective infection prevention and control systems.
• Ensure all mandatory and role specific training is carried out for relevant staff.
• Carry out portable appliance testing of electrical equipment.
• Restrict unauthorised access to blank prescriptions stored in the reception printer.
• Ensure staff recruitment checks are completed in full.

In addition the provider should:

Review practice policies to ensure they are up to date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice