Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Waddesdon Surgery on 2 September 2015. Overall the practice is rated as good.

We found the practice had made improvements since our last inspection on 17 December 2014. They were meeting regulations relating to the management of medicines, recruitment, handling complaints, monitoring the quality of the service they provided, record keeping and safeguarding that had previously been breached.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• 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.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice was making use of clinical audit tools, intelligence monitoring tools, appraisals, clinical supervision and staff meetings to assess the performance of the practice and its staff.

• The practice had a vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• The practice had an effective governance system in place, was well organised and actively sought to learn from previous CQC inspections, performance data, complaints, incidents and feedback.

• The leadership and culture within the practice were used to drive and improve the delivery of high-quality person-centred care. The practice was able to demonstrate year on year improvement.

• We found all the actions had been completed at the inspection on the 2 September 2015. The practice had paid full attention to the report compiled by the commission, where action was required.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Waddesdon Surgery is a semi-rural dispensing practice providing primary care services to patients resident in Waddesdon and the surrounding villages Monday to Friday. The practice has a patient population of approximately 5,272 of which the highest proportion are of working age.

We undertook a scheduled, announced inspection on 17 December 2014. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector and GP specialist advisor. Additional inspection team members were a practice manager specialist advisor and expert by experience.

The overall rating for Waddesdon Surgery was requires improvement.

Our key findings were as follows:

• Patient safety was not given a sufficient priority.
• There was a limited use of systems to record and report safety concerns.
• Some staff were not clear on how to raise safeguarding concerns.
• Staff undertaking chaperone duties did not have training or criminal records checks.
• Patients were able to get an urgent appointment when they needed it. Patients were able to get a routine appointment with a GP usually within two days.
• Patients were able to book an appointment up to a month in advance which helped with planning work commitments.
• Patients were highly satisfied with the care they received.
• Patients told us and we observed staff were caring and treated patients with kindness and respect.
• The practice worked with the multidisciplinary team to support patients and their families with long term conditions and life limiting illness.
• Vulnerable patients with long term conditions had care plans in place to enable care to be delivered at home and to avoid hospital admissions.
• Staff explained and involved patients in treatment decisions.
• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• Feedback was not routinely sought from patients in order to improve and change the service.
• The practice did not have a patient participation group.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure records of staff recruitment checks are accurate and complete.
• Undertake Disclosure and Barring checks or risk assessments for all new staff and those undertaking chaperone duties.
• Ensure there are suitable arrangements to protect patients from the risk of abuse.
• Ensure there is a system to monitor nursing staff are registered with the relevant professional body when recruited and at appropriate intervals thereafter.
• Maintain accurate records of staff training.
• Maintain accurate records of all meetings regarding patient care and treatment.
• Ensure the process for recording and reporting significant events is systematic. .
• Ensure all policies and procedures are up to date and accessible to staff and patients.
• Ensure risk assessments are undertaken to protect patients and staff from risk. For example, the practice environment.
• Ensure there are processes to assess and monitor the quality of the services provided for example, environmental cleaning and stock control.
• Ensure there is a complaints policy/procedure in line with recognised guidance and contractual obligations for GPs in England available for patients.
• Ensure there is a medicines management system for all processes including the security of prescriptions in line with national guidelines.

In addition the provider should:

• Adapt the reception/waiting area to enable patient privacy and confidentiality to be maintained.
• Undertake a risk assessment to evaluate the support patients with a disability may require.
• Follow up outstanding actions from the infection control audit.
• Ensure patient information is kept secure in all practice areas.
• Ensure staff have an annual documented appraisal and personal development plan.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People expressed satisfaction with the practice and explained how they were involved in making decisions about the treatment they received. People told us they were treated with dignity and respect when they called or visited the practice.

People commented, “He is exceptionally good at explaining things.” “You never know what is going to happen with your health…. I have no problems and wouldn’t change my GP for anything”. The practice took a positive approach to ensure the needs of the most vulnerable patients were met.

All staff employed were subjected to character checks and qualified staff had their registration to practice verified.

Quality monitoring systems were in place. Written comments from patients included, ‘Dr Watt is an excellent doctor and a very caring and helpful person. He always goes out his way to help and make you feel relaxed and looked after, like a person he cares about and not a statistic’. ‘I have always had total faith and confidence in Dr Langston. He has never made me feel rushed or hurried no matter how late he may be running. He is polite, friendly, welcoming and always has a smile for his patients. He listens to everything you have to say and never make your worries seem unimportant unlike some Drs I have visited…. If he says he will call, he calls; if he refers you on he always makes sure things are moving’.

Patients we spoke with told us that they would know how to make a complaint should they need to do so.