Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Stag Holyrood Surgery on 13 July 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• 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.
• Most patients said they found it easy to make an appointment with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was creative in its approach to removing the barriers to care faced by individual patients.
• There was a clear leadership structure and staff felt supported by the partners, the lead GP and management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

The practice had recently taken on a caretaking role for a nearby practice that had temporarily closed. However initially, the practice had been given no notice of the closure and was suddenly faced with patients from the closed practice arriving to consult with a doctor. The practice successfully set up a parallel reception, secured additional resources from its staff pool and started running the service the same day without cancelling patient appointments. 

The areas where the provider should make improvement are:

• The practice should ensure its stock of emergency medicines is suitable to cover the needs of its patients, for example, including an injectable antibiotic.
• The practice should put in place a written protocol for its use of patient specific directions (PSDs) and use PSDs more consistently to govern the administration of vaccines by the health care assistants.
• The practice should increase the use of two-cycle audit to demonstrate that improvements to practice are well embedded and sustained.
• The practice should consider ways to improve patient uptake of the national bowel cancer screening programme.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

At a previous scheduled inspection that took place on 31 October 2013 we found shortfalls in relation to the provider's staff recruitment processes. In particular we found that references had not been obtained for all staff prior to them commencing work at the surgery. The provider sent us an action plan on 09 december 2013 explaining how the shortfalls would be addressed.

During this inspection we spoke with the practice manager and looked at records relating to the recruitment of staff. We found that appropriate staff recruitment checks had taken place and recruitment procedures had been updated to ensure that more robust checks were completed before new staff were employed at the surgery.

Staff were encouraged to participate in on going learning and development to ensure they had the skills to carry out their role effectively.

During this inspection, we spoke with five patients. They confirmed that they had been treated with respect and dignity and were satisfied with the services provided. One patient told us, "I am satisfied with my GP. They explain my treatment and have referred me to the hospital specialist when needed”. Another patient said, “I have been coming here for many years. They are pleasant and respectful. They talk nicely to me”.

Patients said they had no problems getting an appointment to see a doctor and rarely had to wait long before being seen. Records indicated that patients were carefully assessed and their care and treatment had been carefully monitored. Reviews of care and treatment with the GP took place and these were recorded.

The practice had a recruitment policy. However, some essential checks had not been carried out prior to new staff being employed. Staff had been provided with essential training and updates. They were aware of action to take when responding to allegations or incidents of abuse.

The practice had an effective system to regularly assess and monitor the quality of service that patients received. A recent patient survey indicated that people were generally satisfied with the quality of services provided. Two members of the patients’ participation group indicated that the views of patients were noted in the way the practice was run.