Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Witton Street Surgery. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring, safe and responsive services. It was also good for providing services to meet the needs of all population groups of patients.

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

• There were systems in place to protect patients from avoidable harm and abuse. Staff were aware of procedures for safeguarding patients from risk of abuse. There were appropriate systems in place to protect patients from the risks associated with medicines. The staffing numbers and skill mix were reviewed to ensure that patients were safe and their care and treatment needs were met. We found improvements should be made to the records for staff recruitment.

• Patients care needs were assessed and care and treatment was being considered in line with best practice national guidelines. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed. We found improvements should be made to the records of staff training.

• Feedback from patients showed they were happy overall with the care given by all staff. They felt listened to, treated with dignity and respect and involved in decision making around their care and treatment.

• The practice planned its services to meet the differing needs of patients. The practice encouraged patients to give their views about the services offered and made changes as a consequence.

• Quality and performance were monitored, risks were identified and managed. The practice ensured that staff had access to learning and improvement opportunities.

We saw an area of outstanding practice:

• The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, one of the GPs was the Clinical Commissioning Group (CCG) lead for the IRIS programme (a general practice-based domestic violence and abuse (DVA) training support and referral programme). The GP lead was also involved in the training and raising awareness with all practices within the CCG area. Involvement in this programme had resulted in the practice identifying more patients at risk of domestic violence. The CCG had also identified the practice as being a high referrer for patients to gain support from other agencies to improve their health, safety and wellbeing. Reception staff were aware of the practice’s involvement in this programme and ensured any patients who appeared to be distressed or injured were seen by a GP immediately. The GP lead for the programme ensured all clinicians had access to information leaflets to share with patients during consultations. The practice also supported partner agencies to access the practice to ensure vulnerable patients were seen in a safe environment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Witton Street Surgery on 19 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We have rated this practice as good all population groups.

We rated the practice as requires improvement for providing safe services because:

• The systems for monitoring medicines needed to be more robust.

We rated the practice as good for providing effective, caring, responsive and well-led services.

We found that:

• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff were provided with the training and support required for their roles.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice monitored patient access to services. They adjusted access to ensure that it met the needs of patients.
• The practice organised and delivered services to meet the needs of patients.
• There was a system in place for investigating and responding to patient feedback including complaints.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The area where the provider must make improvements are:

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

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Provide guidance to all staff on the updated safeguarding policies and procedures.
• Monitor the system to record spot checks of the cleaning undertaken by the cleaners and to record when equipment and clinical areas are cleaned.
• Record all significant events on one record to enable patterns and trends and progress to be more easily identified.
• Review the system to monitor safety alerts.
• Introduce a comprehensive programme of quality improvement and use this information about care and treatment to make improvements.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice