We carried out an announced comprehensive inspection at Watton Medical Practice on 20 March 2018. The surgery was inspected on 15 August 2017 and rated as requires improvement overall; with a rating of requires improvement for all domains and population groups. The practice was given requirement notices for regulation 12 (safe care and treatment) and regulation 17 (good governance). This inspection was to inspect whether sufficient changes had been made in response to those requirement notices.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

• The practice had 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.

• Arrangements were in place to support safe prescribing and the prescribing policy had been updated.

• Infection prevention and control was well monitored in the practice. During this inspection there were no out of date items found in clinical rooms.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.

• We found some exception reporting was above local and national averages, however there was evidence that this had improved since the last inspection.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice was aware of the low results for the GP Patient Survey and they had already changed the appointments system to improve access. The practice had also completed their own survey which showed marked improvements in patient satisfaction.

• Staff reported that they felt confident about the changes made and were positive about the future of the practice.

• There were infrequent administration and reception meetings to share learning. However, there were systems within the practice to keep staff up to date with information.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Continue to review and improve exception reporting, specifically that relating to mental health.

• Continue to review and improve patient satisfaction relating to access, specifically for outcomes relating to access via the telephone.

• Continue to review and improve patient satisfaction relating to caring outcomes.

• Improve the frequency of administration and reception staff meetings to ensure appropriate information is discussed.

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 Watton Medical Practice on 15 August 2017. 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 a system in place for reporting and recording significant events. The practice were in the process of implementing a new system for the sharing of significant events.
• The practice demonstrated safe prescribing, however the policy required review. After the inspection, the provider sent in a policy relating to prescribing and has told us this is being embedded with staff. We found patients on high risk medicines and patient safety alerts were managed; however, there was no defined system for who was responsible for managing these.
• On the day of inspection, we found out of date items in a nurse room. These were removed immediately.
• The practice had a range of risk assessments to monitor and improve safety.
• 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.
• There was limited evidence of quality improvement through clinical auditing.
• Results from the national GP patient survey showed patients rated the practice as below local and national averages for several aspects of care, including access. The practice had employed an external company to help advise them on improving patient engagement.
• Patients reported they were treated with care, dignity and respect.
• The practice had identified 0.75% of the population as carers.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However, there was no trend analysis of complaints.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvement are:

• Continue to identify carers and consider the need for health checks for this patient group.

• Continue to assess and ensure improvement to national GP patient survey results relating to patient satisfaction.

• Implement the plan to drive improvement through clinical audit.

• Review and analyse trends in complaints.

• Continue to ensure effective communication and engagement with patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We conducted a comprehensive inspection on 25 November 2014 under the new approach.

Our key findings were as follows:

The practice was safe, effective caring and responsive and well led. The practice has a clear vision and set of values which are understood by staff and made known to patients. There is a clear leadership structure in place, quality and performance are monitored and risks are identified and managed.

Staff recognised and understood the needs of patients and tailored access to care and treatments to meet these needs. The practice was working in partnership with other health and social care services to deliver individualised care.

The practice provided a safe service in an environment which was well managed and risks to staff and patients were identified and minimised.

Staff were trained and supported to deliver high quality patient care and treatment and to improve outcomes and experiences for patients.

We saw several areas of outstanding practice including:

• The practice paramedic provided monthly basic life support and defibrillation training at the practice which staff could attend as often as they felt they needed to. This ensured that all practice staff felt competent and could effectively respond to an emergency in the practice. The practice paramedic also offered basic life support and defibrillation training to patient groups and local organisations. This meant that the practice was proactively offering health education around emergency response to staff and the local community.

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

Importantly the provider should:

• Ensure the process for recording and documenting all staff meetings is formalised.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice