Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mangwana and Partners, The Surgery on 17 November 2015. The practice was rated as requires improvement for providing effective and responsive services and the overall rating for the practice was requires improvement. The full comprehensive report on the November 2015 inspection can be found by selecting the ‘all reports’ link for The Surgery – Dr Mangwana and Partners on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 18 July 2017 to check for improvements since our previous inspection. Overall the practice is now 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. However, there was no effective system in place to monitor patients on high risk medicines.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they could make an appointment with a named GP in a reasonable timeframe and there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• There was a leadership structure although not all staff were clear on who to report to with specific concerns. Staff felt supported by management however some staff said they would like more opportunities for career progression.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Ensure the proper and safe management of higher risk medicines

In addition, the provider should:

• Implement a register of vulnerable children to manage and review risk

• Provide more support for staff to develop their roles within the practice

• Continue to identify and support patients who are carers

• Clarify the governance structure with clear lines of responsibility

• Consider ways to improve child immunisation uptake rates

• Develop a comprehensive program of quality improvement including clinical audit

• Formalise the strategy to deliver the practice vision

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 at Dr Mangwana and Partners, The Surgery on 17 November 2015. Overall the practice is rated as requires improvement.

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, with the exception of those relating to safeguarding and arrangements to deal with emergencies.

• Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• There was no practice complaints policy in place procedure in line with recognised guidance and contractual obligations for GPs in England.

• Patients said they found it easy to make an appointment with a named GP and that 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 must make improvement are:

• Ensure all staff receive safeguarding training and annual basic life support training relevant to their role.

• Implement a programme of quality improvement to include clinical audit to improve patient outcomes.

• Develop the practice complaints policy and procedure in line with recognised guidance and contractual obligations for GPs in England, maintain a log of all complaints received and analyse these in order to share lessons learned with staff.

The areas where the provider should make improvement are:

• Ensure all staff who act as chaperones have been trained to provide this role and the service is advertised as available to patients.

• Develop an inventory of all clinical equipment used within the practice.

• Develop a comprehensive business continuity plan for major incidents such as power failure or building damage which includes emergency contact numbers for staff.

• Ensure all policies are available to all staff and are practice-specific rather than generic.

• Advertise the translation service within the practice to inform patients this support is available to them as required.

• The practice should ensure systems are in place to proactively identify patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice