We carried out an announced comprehensive inspection at The Weaverham Surgery on 17 December 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service 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.

We have rated this practice as good overall and good for all population groups.

We found that:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• 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.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The most recent results from the GP national patient survey (August 2018) showed patient satisfaction with the service for making an appointment, appointment times, overall experience and getting through to the practice by telephone were below local and national averages. The provider had made changes to the service to address this and was continuing to monitor patient satisfaction through patient feedback.
• The practice organised and delivered services to meet the needs of patients.
• There was a system in place for investigating and responding to patient feedback including complaints.
• There was a focus on continuous learning and improvement at all levels of the organisation.

Whilst we found no breaches of regulations, the provider should:

• Introduce a system to monitor two-week rule referrals to ensure patients receive the tests they are referred for.
• Record a risk assessment to demonstrate how the range of emergency medications held was determined.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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

This is the report of findings from our inspection of The Weaverham Surgery.

We undertook a comprehensive inspection on 16 June 2015.

Overall, the practice was rated as Good. A safe, caring, effective, responsive and well- led service was provided that met the needs of the population it served.

Our key findings were as follows:

• There were systems in place to protect patients from avoidable harm. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents. Systems were in place to ensure medication, including vaccines were appropriately stored and in date.

• The GP lead for safeguarding had carried out an audit cycle on four occasions which led to increased numbers of children identified at risk being coded correctly. The practice gave good evidence to show improvements in patient care and safety over the four cycles.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Feedback from patients and observations throughout our inspection highlighted the staff were caring and helpful. The practice was responsive and acted on patient complaints and feedback. The practice planned its services to meet the differing needs of patients. The recent revision to the audit of phone lines and increased staff availability to answer telephones, improved access to the appointment system. The practice encouraged patients to give their views about access to the services offered.

• The premises were clean and tidy. The practice had good facilities and was well equipped to treat patients and meet their needs in a purpose built building that had been recently refurbished and extended.

• There was a clear leadership structure and staff felt supported by management. Quality and performance were monitored, risks were identified and managed. The staff worked well together as a team.

• We saw areas of outstanding practice including:

• The lead safeguarding GP demonstrated good liaison with partner agencies such as social services, Child and Adolescent Mental Health Services (CAMHS), Early Support and Access Team (ESAT) and the Contact and Referral Team (CART). Recent examples of good joint working with these agencies helped protect and safeguard vulnerable patients and families. The GP lead attended multi-disciplinary meetings with health visitors and local authority leads to help rewrite the safeguarding policy and standardise coding. As a result, staff were able to easily cross reference children at risk, to aid identification and had regular updates with health visitors to keep updated with children at risk.
• One GP set up a social media account which provided the surgery with a large group of patients to engage with. They had contact with over 93 patients across a wide demographic group of patients mainly under 55 years. The GP checked the account twice daily and published various practice information and health advice and sought feedback from patients using the social media tools available.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with six patients who told us they were happy with the consultations they had with their GP. They said they had time to discuss their concerns during the consultation and that treatment, tests and test results were explained to them. They said that where needed they were given written information about health conditions. All said that they were able to get an appointment when they needed one however five of the six patients said that it could be difficult getting through on the phone to arrange an appointment or get results. Some comments made were:-

“Getting through on the phone to make an appointment can be annoying but it doesn’t change the good care received.”

“It’s a very good practice.”

“I am always treated with care and kindness.”

“I am happy with the service provided.”

We found that patient's privacy, dignity and independence were respected.

There were practices in place to ensure patients experienced care and treatment that met their needs.

Appropriate measures were in place to ensure vulnerable adults and children were protected from abuse.

We found that the service had quality assurance systems to ensure patients were protected from risks to their health, welfare and safety.

We saw that results from the National Patient Survey in 2012, feedback from patients on the NHS Choices website for the past twelve months, an analysis of complaints over the last twelve months to the service and three complaints made to CQC indicated that patients experienced difficulty getting through on the telephone to make an appointment. There were also concerns around getting an appointment, delays in getting prescriptions and delays in referrals on to consultants. We found that the service had responded to some of the feedback and had made changes as a result. However, there was no method of collating all patient feedback from all sources to identify patterns and trends. This would then enable a robust plan of action to be put in place as to how the main issues identified were to be addressed.