Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Misbourne Practice in Chalfont St Peter, Buckinghamshire on 28 October 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.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• 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.

• There was an effective system to assess, manage and mitigate risks across the two sites the practice delivered clinical services from. For example, there was a standard operating procedure, protocol and risk assessment for the practice’s use of liquid nitrogen.

• An understanding of the clinical performance and patient satisfaction of the practice was maintained. The practice had proactively improved QOF performance and implemented actions to review and improve already high levels of patient satisfaction.

• Feedback from patients relating to access to services and the quality of care was significantly higher when compared with local and national averages. This was corroborated by written and verbal feedback collected during the inspection.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, with the National Epilepsy Society and other practices within the local GP Federation.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.

The areas where the provider should make improvement are:

• Ensure an action plan for dementia care plans with a view to increase the number of yearly reviewed care plans is monitored through the practice meetings.

• Promote and display information to alert patients that translation services were available.
• Ensure extended hours appointments details are advertised on the practice website and displayed in the premises.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We spoke with six patients who used the service. Patient’s told us they were treated with privacy, dignity and were respected. Some comments included “Staff are very friendly and kind” and “The doctors always treat me with respect.” One patient told us “My privacy has been respected; whenever I am in the consultation room the doors are always closed.”

Patients we spoke with all told us that they had felt confident with care and support provided by their GP. Patients were complimentary of the service provided to them and of the staff in the practice. Some comments received included “The GP is very compassionate and sensitive to my needs” and “The nursing team here are brilliant.” Patients told us that they felt consulted and involved in the care and treatment provided to them. One patient told us “I have found the GP never rushes me, he always provides very comprehensive and detailed consultations.”

Patients we spoke with told us that they had felt safe and confident with the care provided at the practice. Comments included “Oh yes, I feel safe with all the staff” and “The environment here is very safe, no reason to be concerned.”

We found patients who used the service were not fully protected from the risk of abuse, because the provider had not taken all reasonable steps to identify the possibility of abuse and prevent abuse from happening. Patients were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place store to store medication safely and securely.

We reviewed the information available to us about The Misbourne Practice on 22 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.