Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Sheldon Practice on 22 December 2015. 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.
• 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.
• Patients said they were involved in their care and decisions about their treatment but the practice scored below average on this aspect of the service in the latest national GP patient survey.
• Some patients told us they had to wait too long after their appointment time before being seen.
• 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.
• 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 improvement are:

• All staff should have annual basic life support refresher training and the practice should be able to evidence this.
• The practice should develop a register of patients who are carers and a strategy for identifying and supporting carers.
• The practice should develop its own internal programme of clinical audit to drive quality improvement in line with practice priorities.
• The practice should provide regular opportunities for non-clinical staff to meet as a team and keep minutes for future reference.
• The practice should review ways to increase patient uptake of bowel cancer screening.
• The practice should reduce delays and overrunning of appointments where possible.
• The practice should improve its patient feedback scores in relation to involving patients in decisions.
• The practice should introduce the facility to book appointments online.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our last inspection on 20 December 2013 we found that there were inadequate systems in place in relation to fire safety that may have posed a risk to people using the service and staff. In addition to this there were no cleaning schedules in place to ensure that all areas of the practice were cleaned at regular intervals to prevent the spread of infection. Following our inspection the provider developed an action plan detailing how these issues would be addressed.

During this inspection we spoke with the practice manager and two other members of staff. We found that systems had been introduced to record regular checks on fire safety equipment and a fire risk assessment had been completed. Regular fire drills were also taking place and a fire evacuation plan was in place.

We saw cleaning schedules that had been developed for the practice and viewed records that had been completed by the cleaner once cleaning tasks had been completed. The schedules included tasks such as cleaning office equipment and clinical equipment which was cleaned by other members of staff at the practice.

We spoke with eight people who used the service. Each person we spoke with told us that there had been a lot of changes in the staff over the last few years, which impacted on the quality of the service they received. One person told us "For a while every time I came it would be a different doctor. I had to explain everything, start from scratch, every time. There was no continuity of care". Another person said "The doctors try their best but it's hard when they keep changing. You need to build up a relationship, get to know people to provide the best care". A third person said "It's been a lot better for the last six months or so, now they have stable staff".

We found that the service met people's needs, but hadn't thoroughly planned for some foreseeable emergencies. People were protected from the risk of abuse, and staff were appropriately skilled, qualified and experienced for their roles.

We saw that the provider had taken steps to reduce the risk of healthcare-associated infections, but did not have a cleaning plan and records that met government guidelines.

The provider had a system in place to assess and monitor the quality of the service people received, and sought and acted upon feedback.