Letter from the Chief Inspector of General Practice

This inspection was an announced focused inspection carried out on 22 August 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 on 21 July 2016. At that inspection we rated the Safe, Responsive and Well-Led domains as Requires Improvement and Effective and Caring as Good leading to an overall rating of Requires Improvement. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Whilst the Safe and Well-Led domains are now rated as Good the Responsive domain is still rated as Requires Improvement.

Overall the practice is now rated as Good.

Our key findings were as follows:

• The National Patient Survey scores published in January 2017 were still significantly lower than the national average in a number of areas and whilst some improvements had been made this was still an area for improvement.
• The practice had taken action to install fire smoke detectors and for all portable electrical equipment to be tested annually.
• The practice’s fire evacuation plan was on display in several prominent places, including the waiting area and staff were aware of their responsibilities.
• As part of its comprehensive refurbishment programme, new flooring had been laid in all clinical areas, which included coved skirting, thereby reducing the risk of cross infection.
• The practice had installed new wash hand basins in all clinical rooms which were without plugs and with a smooth surface splash–back.
• The premises, whilst still limited for space were more suitable for the purpose of providing primary care, particularly in the new nurse’s room.
• The waiting area had been redesigned, thereby offering patients easier access to the reception desk and other clinical rooms.
• The practice had carefully considered the management of patients with long term conditions and had introduced additional doctor and nursing support to improve the management of these patients. They had evaluated and reviewed patients who had been exception reported in all clinical domains and were particularly looking at reducing exception reporting for both their COPD and mental health patients. A significant improvement had been seen in the exception reporting of their atrial fibrillation patients.
• The practice’s uptake for cervical screening was currently at 68% and the target was 80%. They were encouraging more females to engage in this programme, but had historically encountered some ethical issues. Further improvement was anticipated as a result of more input from GPs and additional nursing time.
• Uptake rates for childhood immunisations were currently 89% to 96% for 1 year olds and 84% to 94% for 2 year olds and above. These figures compared favourably with CCG and national rates.

The number of carers had increased to 216, which was 4% of the practice list size. Staff remained focused on increasing this number further.

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

         The provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, specifically relating to the review of and acting upon patient feedback on accessing services.
• The provider should:
• Install a privacy curtain around the examination couch in one of the GPs rooms.
• Remove patient’s paper records from an unlocked cupboard in the nurse’s room and keep in a secure place. 
• Permanent locums were part of the clinical team, however clinical matters were not being formally discussed with them, thereby ensuring they were fully involved in influencing how high quality care could be delivered and recorded.
• Consider the practicalities and seek professional guidance of how to safely evacuate a disabled patient through the fire exit to the rear of the premises, as access to this was not straightforward.
• Ensure the locum GPs training needs and records were up-to-date.
• Extend the cleaning record and checklist to include all areas.

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 The Drive Surgery on 21 July 2016. Overall the practice is rated as requires improvement.

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

• Risks to patients were assessed, however they were not always addressed quickly enough.
• The premises were cramped, the layout was poor, and the decorations, floor coverings and some furniture were worn out, which made it hard for patients to access services.
• Patients found it difficult to make an appointment when they wanted one although urgent appointments were available the same day.
• There was however an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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.
• The practice had the clinical equipment to treat patients.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on within the constraints of its premises. There were no contingency plans in place to make needed improvements should the proposed move to new premises not proceed within an appropriate timeframe, if at all.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure the safety of patients by completing actions identified for urgent action through the fire risk assessment and infection prevention audit, both carried out in January 2016.

• Ensure its premises are suitable for the purpose of providing primary care.

• Ensure action is taken to improve patients’ access to the service.

The areas where the provider should make improvement are:

• Consider further ways of meeting the needs of patients with long term conditions given the comparatively high exception reporting rates in some clinical domains.

• Put systems in place to improve the identification of people amongst the practice population who are carers, to support a proactive approach to meeting their specific needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice