Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at White Horse Health Centre on 19 October 2016. Overall the practice is rated as good.

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

• The practice recognised the value of learning from significant events and had a system to review them regularly and as part of everyday practice. The practice carried out a thorough analysis of the significant events to look for root causes, ways to prevent any reoccurrence and to identify any improvements needed.
• Risks to patients were assessed and well managed.
• The practice had a patient focussed approach to patients over 75 who may have health risks associated with frailty. The nurses conducted home assessments, worked with other providers to provide the best care package, conducted health checks and focussed on prevention and health education.

• 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; they were proactive about development and learning opportunities. We saw staff cascading learning and development from training events to the rest of the staff.

• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs. At White Horse Health Centre patients could access a number of services provided by other care providers including; speech and language therapy, a hearing aid repair clinic, breast screening, mobile chemotherapy, dental services and an X-ray clinic.
• 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 and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice had developed a frailty assessment template which included care support and care planning and covered the whole patient’s experience of changing energy, physical ability, cognitive and health needs and social and environmental factors. The template was shared with NHS England and shared across the clinical commissioning group

The areas where the provider should make improvement are:

Ensure all actions taken when the dispensary fridge recorded temperatures are outside of the normal range are documented.

Ensure all controlled drugs that had been returned by patients are recorded until are destroyed.

Ensure the exception rates are reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating from October 2016 – Good)

The key questions at the October 2016 inspection were rated as:

• Are services safe? – Good
• Are services effective? – Good
• Are services caring? – Good
• Are services responsive? – Good
• Are services well-led? – Good

We carried out an announced comprehensive inspection at White Horse Health Centre on 29 & 30 August 2018, as part of our inspection programme.

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.
• 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.
• The practice had developed a clear dementia strategy to improve their care for patients with this illness, which included an action plan. This included the practice working to become accredited as being a dementia friendly service.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• The practice must ensure all staff receive such appropriate support, training, professional development, as is necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvements are:

• Improve systems for the handling, monitoring and recording of safety alerts.
• The practice must act to reduce their exception reporting rates.
• Improve systems for monitoring all prescription forms.
• Improve systems for recording staff DBS checks.
• Improve systems to ensure all complainants are given information about how to escalate their complaint if they were unsatisfied with the practice response.
• The provider should continue to make efforts to increase the programme coverage of women eligible to be screened for cervical cancer.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice