Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thornbury Medical Practice on 28 September 2017. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report complaints and significant events. However, the outcomes of these reviews and any lessons learned were not regularly discussed at staff meetings or shared with staff.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. The practice had identified that not all the senior staff at the practice had received safeguarding training to the required level.
• Data showed patient outcomes were comparable to local and national averages.
• The latest National GP Patient Survey results for the practice showed lower than average numbers of patients said they were treated with care and concern by their GP. The survey data also showed that patients found making and accessing appointments difficult. However, the majority of patient comment cards and patients with whom we spoke on the day did not confirm this opinion, and said that access to appointments had recently improved.
• The practice had a number of policies and procedures to govern activity, but some were not dated or were overdue a review.
• Risks to staff and patients were assessed and well managed, with the exception of those relating to the administration of medicines by Patient Group Directions (PGDs). We saw PGDs had been adopted by the practice to allow nurses to administer medicines in line with legislation but we found that these had not been signed by the authorising body. (PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.)
• The practice did not maintain oversight of the immunisation status of the staff team and did not follow their own policy with regards to the Hepatitis B immunity status of staff.
• There was a clear leadership structure and staff felt told us that they felt very supported by management. The practice had a patient participation group and health champions which met regularly.
• The pharmacist had undertaken an audit of patients who required a medication review. A high number of these were found to be overdue and a system had been implemented to address this issue.

The areas where the provider must make improvements are:

• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Continue to review the results of patient satisfaction surveys and ensure that it can meet the needs of their patient population in the future and improve outcomes.
• Continue to review access to the service and assure themselves that they are able to provide an appropriate number of appointments to meet patients’ needs.
• Continue to review the medication needs of all patients and be able to assure themselves that all patients’ medications are reviewed as required.
• Implement a schedule for the cleaning of clinical equipment to assure themsleves that this meets best practice for infection prevention and control.
• Continue to improve the identification of carers to enable this group of patients to access the care and support they require.
• Continue to take steps to improve their cancer screening uptake rates within their population including breast and bowel screening.

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 Thornbury Medical Practice on 10 November 2015. Overall the practice was rated as good. However of the practice was rated as requires improvement in the key question of Responsive. After the inspection the practice wrote to us to say what they would do to meet the requirements in relation to the responsiveness of the practice.

We undertook a focussed follow up inspection at Thornbury Medical Practice on 8 February 2017 to check that the practice had made the improvements required. This report only covers our findings in relation to those requirements. The practice is now rated as good for providing responsive services.

You can read the full comprehensive report which followed the inspection in November 2015 by selecting the 'all reports' link for Thornbury Medical Practice on our website at www.cqc.org.uk.

Our key findings across all the areas we inspected were as follows:

• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. For example via the PPG newsletter and via protective learning time for staff.

• The practice developed effective ways of deploying temporary staff e.g. Locums. The practice now only used two long term locums.

• The practice looked at ways of making sure patients had access to prompt medical care. The practice had an on call system everyday weekday from 8am to 6pm.

• The practice explored avenues of staffing and skill mix to ensure the practice was adequately staffed in the medium to long term. The practice now employed a full time health care assistant.

The provider should:

• The practice should continue to monitor and take steps to improve patient’s satisfaction with access to the practice by telephone.

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 Thornbury Medical Centre on 10 November 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 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.

• On the whole 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. There were some accesses problems that the practice needs to address.

• The practice had facilities and was equipped to treat patients and meet their needs.

• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice:

• A flu vaccination analysis was implemented recently in conjunction with the local pharmacist which resulted in saving the practice 850 appointments. The practice manager told us that Flu clinics for inviting patients were sent out. The practice set up a structured campaign targeting certain groups of patients and also giving opportunistic vaccinations with the largest increase being in pregnant women.

The areas where the provider should make improvement are:

• The practice should explore effective ways of deploying temporary staff e.g. Locums.

• Effectively investigate performance data and patient feedback which might indicate potential risks to care.

• Look at ways of making sure patients have access to prompt medical care.

• Explore all avenues of staffing and skill mix to ensure the practice is adequately staffed in the medium to long term.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients told us they were treated with care and respect and we saw positive interactions between patients and staff. One person said, “They’re alright here, I’ve been coming for years here”. All the patients we spoke with told us there could be problems getting an appointment although once they had got through to the surgery the service offered was good.

The staff we spoke with were aware of their responsibilities to report safeguarding matters to the relevant safeguarding authorities and to the Care Quality Commission (CQC).

An infection control policy was in place which was reviewed regularly.

The Practice Manager was aware of the recent changes from Criminal Record Bureau (CRB) checks to Disclosure and Barring Service (DBS).

People were made aware of the complaints system and details were available on the scrolling computerised practice screen above reception. This was provided in a format that people could understand and gave details of who to speak with.

We carried out an announced comprehensive inspection at Thornbury Medical Practice on 17 May 2018. The overall rating for the practice at that time was good. However, the practice was rated as requires improvement for providing caring services. The full comprehensive report on the May 2018 inspection can be found by selecting the ‘all reports’ link for Thornbury Medical Practice on our website at www.cqc.org.uk .

This inspection was an announced focused follow up inspection carried out on 19 March 2019 to review the practice in relation to the key question of caring and the services offered to patients. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

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 for providing caring services.

We found that:

• The practice had identified an increased the number of patients who were carers and were offering health and social opportunities and support for these patients.
• The practice had reviewed and responded to the GP patient survey 2018. Changes were made as a result of feedback from patients.
• The provider had considered the needs of vulnerable patients and offered priority appointments and telephone support to suit individuals.

At the inspection on 17 May 2018 we highlighted a number of areas where we said the practice should improve. At this inspection we saw that:

• The practice had increased the prevalence of patients with mental health needs to 1% which was above CCG average. The practice had identified a GP mental health lead who, with support from a member of the administration team, regularly reviewed the needs of patients on the mental health register. The practice survey showed that 82% of patients felt their mental health needs were met during their last consultation. Three separate invitations were sent to this patient group to remind them of their reviews. If this method failed, the GP would ring the patient. For patients who declined to attend for reviews support would be offered over the telephone. The practice worked with local mental health teams to ensure the needs of this vulnerable group were met.
• A new recall system was in place to encourage and monitor cervical screening at the practice. The team were targeting young people before their 25th birthday to proactively offer screening. Reports were run and reviewed by the nursing team every 30 days and additional letters printed on pink paper. Telephone calls were made to those who had failed to attend. The practice nurse was allocated six hours per month to review, call and support patients to attend for screening. Outcomes were reviewed with the GP screening lead, at nurse and clinical meetings and by way of a bi-annual audit. Outcomes for breast and bowel cancer screening were above national averages.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information