This practice is rated as Good overall. (Previous inspection May 2018 – Good)

The key questions are rated as:

Are services safe? – Good

We carried out an announced comprehensive inspection at Porch Surgery on 29 May 2018 as part of our inspection programme. We rated the practice as Requires Improvement for the provision of safe services because:

• The practice did not monitor the temperature of their vaccine fridges in line with recommended guidance.
• The practice did not take appropriate action when the temperature of the vaccine fridges went above the recommended limit in line with their policy or national guidance.

The full report on these, inspections can be found by selecting the ‘all reports’ link for Cross Plain Health Centre on our website at .

This report covers the inspection we carried out on 5 February 2019, to review the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements in relation to for the provision of safe services. We based our judgement of the quality of care at this service is on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

At this inspection we found:

• The practice had systems for the appropriate and safe use of medicines, including medicines optimisation. The practice had made significant changes to their processes and systems relating to the management of vaccines and were now meeting the regulatory requirements.
• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.
• The practice had clear 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.
• Appropriate standards of cleanliness and hygiene were met.
• The practice learned and made improvements when things went wrong.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

The key questions are rated as:

• Are services safe? – Requires Improvement
• 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 Porch Surgery on 29 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice told us they had been having difficulties in recruiting staff particularly GPs. They had recently filled the key vacancies although it would be some weeks before the new staff were in post.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen.
• The practice did not follow guidance around the safe storage and monitoring of vaccinations requiring refrigeration.
• 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.
• In the year 2017/18, the practices’ smoking cessation service had achieved a 64% quit rate, which was higher than the national average of 52%.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice had an active Patients Participation Group who the practice engaged with to support service developments.

The areas where the provider must make improvements are:

• The provider must ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• The provider should review the newly implemented system for sharing learning points from complaints and significant events to ensure it is effective.
• The provider should review their policy relating to portable appliance testing and their systems for its effective operation.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Porch Surgery on 20 September 2016. Overall the practice is rated as good, and outstanding for providing responsive services.

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 well 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.
• The patient participation group (PPG) were well engaged and represented the patient population across a diverse range of professional backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services.
• 97% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 86% and national average of 84%.
• The practiced worked closely with a local charity that provided patient transport.
• The practice was participating in a social prescribing scheme to support people who attended their GP surgery but did not necessarily require medical care. Social prescribing supports people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that can help improve their wellbeing and meet their wider needs.
• Staff had lead roles that improved outcomes for patients such as a care co-ordinator.
• Patients had access at the practice to drop-in clinics from outside agencies for example those specialising in bereavement care.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary booked for a same day appointment at the practice.
• 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.
• A leaflet was available at reception with introductory phrases available in a range of different languages, for patients who attended the practice and who English as a second language.
• The practice was proactive in developing services that met patient needs. For example, the practice helped to co-ordinate meetings with agencies concerned with supporting local patients who need additional help, but would not ordinarily come under the remit of General Practice. A directory of local support and services has been developed as a result of the meetings.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
• The practice hosted a talking therapy service for patients who had experienced a bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.

We saw five areas of outstanding practice:

• The practice nurse manager visited a local nursery school to provide basic life support classes for children. The nurse manager used an anatomical skeleton model to inform children about the structure and function of bones; and a medical resuscitation doll when informing children about who to contact, when faced with an unconscious patient.
• The practice was proactive in developing links with a local secondary school, to identify children who were carers. At the time of inspection, the practice was in regular contact with three school children who were carers, and provided advice and support.
• The practice was proactive in engaging with the local Travellers community. Immunisation rates for Travellers registered at the practice had increased over the last two years. At the time of inspection, 13 (of 15) children under five years old had received a full course of vaccines, with the remaining two children due to complete their full course of vaccines.
• Practice staff designed a template to record any concerns they may have about a patient’s welfare. The completed template was then referred to the safeguarding lead, and linked with the practice’s safeguarding processes.
• The practice initiated, set-up and developed ‘The Brunel Shed’, which uses woodwork and other activities to help patients combat social isolation, share resources and learn new skills.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We were welcomed by patients and all members of staff when we visited. The inspection was announced to the service 48 hours prior to our visit. The GP’s, practice manager and staff had considered a programme of events for our visit so that we had a useful variety of patients and staff to speak with. This included us attending a GP/nurse consultation.

Patients were complimentary about the practice and did not express any concerns. Comments included, “I am treated well and I am confident in their hands”, “Reception staff are courteous and do everything they can to help you” and “The surgery has grown over the years but it still retains that charm of a family run practice”.

We were supported throughout our visit by a dedicated management team and various other clinical and non-clinical staff. All staff involved in the inspection clearly supported the practice and their commitment to deliver high quality clinical and medical services in a manner that would significantly improve the patient experience.

We spoke with and observed staff throughout our visit. Staff were very clear about their roles, responsibilities and professional accountability. They were confident in their chosen roles and shared with us their experiences working at the practice.

We found the practice was complaint in all five outcomes that we looked at.