Letter from the Chief Inspector of General Practice

Our previous comprehensive follow up inspection in January 2016 found issues relating to the responsive delivery of service and we asked the practice to make further improvements in the appointment booking system. We found The Orchard Surgery required improvement for the responsive domain. The practice was rated good for providing safe, effective, caring and well-led services.

This follow up focussed inspection on 15 September 2016 was undertaken to check whether the practice had made necessary changes following our inspection in January 2016. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 6 January 2016.

At our inspection on the 15 September 2016 we found the practice had made improvements since our last inspection. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of responsive service.

Specifically we found:

• The practice had taken number of steps to improve the appointments booking system and access to a named GP. For example, the practice had increased GPs sessions from 25 to 37 sessions per week and introduced 12 online GPs appointments for same day which were released 60 minutes before the practice opening times.
• The practice had increased the number of online appointments and there was a dedicated member of staff who was monitoring appointment booking system. This included the duration it takes to answer the telephone calls.
• The practice had carried out an internal survey in August 2016, which showed improved results and patients were satisfied with their access to care and treatment.
• The practice was in the process of installing two additional telephone lines, recruited four administration staff, a health care assistant and a clinical pharmacist to take the lead role in carrying out medicine reviews which would increase GP capacity allowing the practice to offer additional GP appointments.

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 of The Orchard Surgery, Willow Parade, 276 High Street Langley, Slough, Berkshire, SL3 8HD on the 6 January 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in May 2015 found breaches of regulations relating to the safe, effective, caring and responsive delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in May 2015 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At the inspection in January 2016, we found the practice had made significant improvements since our last inspection in May 2015 and that they were meeting the regulations which had previously been breached.

Specifically, we found the practice to require improvement for the provision of a responsive service. It was good for providing safe, effective, caring and well led services.

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

• All the partners and staff worked hard to undertake a complete review of the service since the previous inspection and made sustainable improvements.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded, monitored and reviewed.
• Risks to patients were assessed and well managed.
• We found that completed clinical audits cycles were driving positive outcomes for patients.
• 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 were available and easy to understand.
• Patients said they found it difficult to make an appointment with a named GP and had to wait a long time to get through to the surgery by telephone each morning. Urgent and online appointments were 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.

The areas where the provider should make improvements are:

• Further review the appointments booking system and the waiting time it takes to get through to the practice by telephone. Improve the availability of non-urgent appointments with a named GP.
• Implement a system to promote the benefits of breast screening and flu vaccination rates for the over 65s to increase patient uptake.
• Ensure to develop and implement clear action plans, to improve the outcomes for learning disabilities patients.
• Take action to review their approach and support for patients with carers responsibility.

I confirm that this practice has improved sufficiently to be rated ‘Good’ overall. The practice will be removed from special measures.

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 of The Orchard Surgery, Willow Parade, 276 High Street Langley, Slough, Berkshire, SL3 8HD on the 6 January 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in May 2015 found breaches of regulations relating to the safe, effective, caring and responsive delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in May 2015 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At the inspection in January 2016, we found the practice had made significant improvements since our last inspection in May 2015 and that they were meeting the regulations which had previously been breached.

Specifically, we found the practice to require improvement for the provision of a responsive service. It was good for providing safe, effective, caring and well led services.

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

• All the partners and staff worked hard to undertake a complete review of the service since the previous inspection and made sustainable improvements.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded, monitored and reviewed.
• Risks to patients were assessed and well managed.
• We found that completed clinical audits cycles were driving positive outcomes for patients.
• 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 were available and easy to understand.
• Patients said they found it difficult to make an appointment with a named GP and had to wait a long time to get through to the surgery by telephone each morning. Urgent and online appointments were 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.

The areas where the provider should make improvements are:

• Further review the appointments booking system and the waiting time it takes to get through to the practice by telephone. Improve the availability of non-urgent appointments with a named GP.
• Implement a system to promote the benefits of breast screening and flu vaccination rates for the over 65s to increase patient uptake.
• Ensure to develop and implement clear action plans, to improve the outcomes for learning disabilities patients.
• Take action to review their approach and support for patients with carers responsibility.

I confirm that this practice has improved sufficiently to be rated ‘Good’ overall. The practice will be removed from special measures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit we were unable to speak to patients. A patient questionnaire was sent out and feedback received was generally positive. Patients were asked if they were treated with respect and dignity and responses included “Most definitely. It is part of the practice ethos and put into practice from the moment you arrive and until you depart” and “Yes. They are always polite and patient and listen to my questions and try to answer all.” Another patient told us “All the ‘front of house’ and medical staff always treat me with respect and dignity and do their best to ensure that my experience when I visit the surgery is a positive one.”

The feedback received from the patient questionnaire was complimentary of the service provided to them and of the staff in the practice. Some comments included “There is a patient centred approach from members of the medical team, support and admin team”, “The Doctors are very good and staff very helpful”, “The Partners are all very approachable and provide a quality service” and “Receptionists and all staff are friendly.”

Patients told us they had felt safe and confident with the care provided at the practice. We found the practice did not have a robust recruitment process in place putting patients at risk of receiving a service from staff members who were not sufficiently vetted.

We found patients were made aware of the complaints system and patient’s complaints were fully investigated and resolved, where possible, to their satisfaction