Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ivy Medical Group on 11 April 2017. The overall rating for the practice was good with a rating of requires improvement for providing well-led services. The full comprehensive report form the April 2017 inspection can be found by selecting the ‘all reports’ link for The Ivy Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 11 April 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:

• Practice workforce arrangements had been reviewed and additional staff recruited to improve stability and continuity. This included management, administrative and clinical staff.
• There was evidence of continued review and monitoring of patient experience information. The practice considered that changes to the staffing arrangements had not yet impacted upon patient experience data.
• Arrangements to monitor and record training had been improved.
• There was evidence of the involvement of regular communication and engagement with established locum GPs.
• Staff appraisals had been undertaken and new staff were given performance reviews.

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

In addition the provider should:

• Continue to review and improve patient experience in respect of continuity of care and access.

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 Ivy Medical Group on 11 April 2017. Overall the practice is rated as good.

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

• There was an effective system in place for the reporting, recording and analysis of significant events. This included near misses and incidents relating to the dispensary service. Lessons were shared to improve safety in the practice, and an annual review had been established to review outcomes and to observe any trends or themes.
• The practice had developed an effective procedure to respond to national safety alerts including those received from the Medicines Health and Regulatory Authority (MHRA). A comprehensive log detailed all alerts that were received, and provided evidence of the follow up action that was taken to keep patients safe.
• The provider had clear arrangements in place to ensure the proper and safe management of medicines. Processes and governance arrangements for managing medicines had been recently reviewed and were working effectively. This included the prescribing, recording, handling, storing, security and disposal of medicines.
• The dispensary was located in shared premises with another practice’s dipensary. The location presented some challenges with regards to security but the practice had identified this and was working to find a long-term solution. Risk assessments were in place to control the area of concern that had been identified.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance, and had documented evidence to support this. Clinical meetings ensured staff kept up to date with new developments.
• The practice was recruiting for additional clinical staff and was due to undertake a national GP recruitment campaign in collaboration with their CCG. Staffing levels at the time of our inspection did not always ensure the needs of patients were met in a consistent or timely way, and the practice was reliant on regular locum GP sessions.
• Staff were supported to complete essential and role-specific training and received appraisals.
• The most recent National GP Patient Survey (July 2016) indicated that patient satisfaction was generally below local and national results in terms of consultations with clinicians and access to appointments. The practice had devised an action plan to improve this with their patient participation group (PPG), and undertook their own internal patient survey to review progress. This indicated that patient satisfaction was improving.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had a main site at Burton Joyce and a branch site shared with another GP practice at Lowdham. The practice had mostly good facilities and was equipped to treat patients and meet their needs. The two sites required some refurbishment and the practice worked with their CCG to review any funding opportunities to support redevelopment.
• There was a clear leadership structure and staff felt supported by management.
• The practice had governance systems in place which were effective and supported the delivery of good quality care and ensured effective oversight.
• The practice participated in new models of care and local pilot schemes to improve patient outcomes in the local area. There was strong engagement with the Clinical Commissioning Group (CCG) and with other local GP practices.
• The practice had a clear forward strategy and were actively looking at ways to develop a structure and model that was fit for purpose to meet future demands.

The areas where the provider should make improvement are:

• Continue to review the practice staffing levels to ensure patients’ needs are met. This should include both clinicians and non-clinical staff. 
• Continue to review, monitor and act upon patient experience data (including the national GP patient survey results) to drive service improvement and improve patient satisfaction.
• Review the practice training matrix and customise this to reflect the practice team’s training requirements.
• Ensure staff appraisals are updated and reviewed on a regular basis.
• Continue to explore a longer-term solution to the security and confidentiality arrangements within the practice dispensary

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice