At our previous comprehensive inspection at Whitchurch Surgery in Buckinghamshire on 5 October 2017 we found a breach of regulations relating to the provision of safe, effective and well-led services. The overall rating for the practice was requires improvement. Specifically, the practice was rated requires improvement for the provision of safe, effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, therefore all population groups were also rated requires improvement. The practice was rated good for the provision of caring and responsive services.

The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Whitchurch Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 5 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in October 2017. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 5 March 2018 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

• There was now an overarching governance framework which supported the delivery of the good quality care.

• The practice had re-established and was now operating safe and effective systems to assess, manage and mitigate the risks identified relating to patient safety, medicine safety and device alerts.

• A system had been introduced to ensure that appropriate monitoring for all patients in receipt of high risk medicines was in place.

• Patient information needed to plan and deliver care and treatment was now available in a timely and accessible way. There was managerial oversight of the correspondence system used to allocate patient summaries from external services. Previous concerns about delays and a backlog of correspondence had been addressed.

• A programme of quality improvement activity had been reintroduced; this included completed and live clinical audits.

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 Whitchurch Surgery in Buckinghamshire on 5 October 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. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. However, we found these systems had not been monitored. For example, we saw that there was a backlog on the patient correspondence system which included letters, discharge summaries, investigation and test results.

• 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.
• Feedback from patients about their care was consistently positive. For example, results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice was working with the clinical commissioning group in the development of defined care pathways for Type 2 diabetes.
• Patients we spoke with 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.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 areas where the provider must make improvements are:

• Ensure safety alerts are received into the practice and implement a system to ensure they are acted upon. Thus ensuring there is a review of all patients that may have been affected by the safety alerts.

• Ensure care and treatment is provided in a safe way to patients including the prescribing of high risk medicines.

• Implement a programme with the view to increase the level of quality improvement; this may include increased clinical audit activity.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice