Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Village Surgery 25 October 2016. The practice was rated as good overall. A breach of legal requirements was found relating to the Well Led domain. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breaches of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that an effective process was in place to distribute safety and medicines alerts to all staff, they had failed to analyse the results of the national GP patient survey and to act on areas where their performance was below average, and they had failed to assess and mitigate the risks relating to recruitment. We also identified areas where improvements should be made, which included reviewing their buddy arrangement with neighbouring practices to ensure that associated risks were identified and mitigated, taking action to reduce their exception reporting rate in areas where it was higher than average, taking action to increase the uptake of cervical screening amongst patients, reviewing how they identified patients with caring responsibilities, advertising the availability of language translation services, ensuring that longer appointments were routinely provided to patients who would benefit from them, ensuring that full details of significant events were recorded, and monitoring the receipt and use of prescription printer sheets.

We undertook this focussed desk-based inspection on 13 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Village Surgery on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for being well led.

Our key findings were as follows:

• The practice had reviewed the results of the national GP patient survey and had taken action in response to areas of below average achievement. They were in the process of analysing the impact of the measures they had put in place.
• The practice had processes in place to ensure that all safety and medicines alerts were distributed to relevant staff, and records were kept of the action taken in response to these alerts.
• Following the initial inspection, the practice had revised its recruitment procedure to include details about the risk assessment they would undertake to determine whether a member of staff required a Disclosure and Barring Service check. We saw evidence that this new process was being followed.
• The practice had a reciprocal arrangement with a buddy practice, which would provide clinical cover in an emergency. We saw evidence that background checks had been completed on relevant members of staff from the buddy practice.
• The practice advertised the availability of translation services and chaperones to patients in the waiting area.
• The practice routinely provided longer appointments for patients who would benefit from them.
• The practice kept a full record of significant events, and details of the event and learning were shared with staff.
• The practice had a system in place to monitor the receipt and use of prescription sheets.
• Following the initial inspection, the practice had increased the number of carers recorded on their system by 25%. They previously had 28 patients recorded as carers and this has increased to 35 patients; however, this was still less than 1% of the patient population.
• The practice had taken action to encourage patients with long-term conditions to attend for reviews. The practice provided us with a year-to-date summary of their achievement for the Quality Outcomes Framework, which showed improvements in several areas.
• The practice was in the process of trying to increase the uptake of cervical screening amongst their patients; for example, a significant proportion of their patient population spoke Arabic or Korean as their first language, and the practice had displayed information about cervical screening written in these languages.

There were two areas where the provider should make improvement:

• They should continue to monitor patient feedback and to make changes to their service to address any areas of low achievement.
• They should continue to work to ensure that patients with caring responsibilities are identified on the clinical system in order that these patients can be offered support.

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 The Village Surgery on 25 October 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; however, in some cases records of significant events should be more detailed.
• Risks to patients were assessed and well managed with the exception of those relating to staffing.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. A system was in place to distribute updated guidance and safety alerts to staff; however, not all staff were included in this and no record was kept of the action taken following alerts.
• 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.
• 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; however, they had not analysed the results of externally collected patient feedback such as the NHS GP Patient Survey and comments on the NHS Choices website.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Take action to analyse the results of the national patient survey to establish the reason for the lower than average scores, and address areas for improvement.
• Ensure that the system for distributing safety updates includes all staff, and that a record is made of the action taken as a result of these alerts.

In addition, they should address the following areas:

• Ensure that the newly revised recruitment procedure is implemented, and that the risks associated with the buddy arrangement with neighbouring practices to provide GP cover have been identified and mitigated.
• Take action to reduce their exception reporting rate in areas where it is higher than the local and national average.
• Take action to increase the uptake of cervical screening amongst their patients.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Advertise the availability of translation services and chaperones for patients.
• Ensure that longer appointments are routinely provided to patients who would benefit from them.
• Ensure that records of significant events record full details of the event and action taken.
• Monitor the receipt and use of prescription printer sheets.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice