We carried out an announced comprehensive inspection at Yorkleigh Surgery-CT on 6 March 2018. The practice was rated as requires improvement for providing safe, effective and well-led services as well as overall. However, the practice was rated as good for providing caring and responsive services. The full comprehensive report of the 6 March 2018 inspection can be found by selecting the ‘all reports’ link for Yorkleigh Surgery- CT on our website at .

This inspection was an announced comprehensive inspection carried out on 16 January 2019. The purpose was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 6 March 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective and well-led services as well as overall. The practice remains rated as good for the provision of caring and responsive services.

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 and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice was working though updating and developing risk assessments and actions had been taken to minimise risk where identified.
• The practice had reviewed its systems to ensure Patient Specific Directions (PSDs) were produced in line with current guidelines. PSDs are written instructions, from a qualified and registered prescriber for a medicine including the dose, route and frequency or appliance to be supplied or administered to a named patient after the prescriber has assessed the patient on an individual basis.
• Recruitment files had been reviewed to ensure all specified information had been obtained and retained when recruiting staff.
• The practice had reviewed staffing arrangements and recruited additional administration staff to support with activities.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Review arrangements so up to date information re on file for locum GPs and salaried GPs.
• Continue to implement actions to improve outcome for patients with long term conditions and review the process for excepting those patients from reviews so that exceptions are applied appropriately when necessary.
• Continue to implement actions to improve uptake for the cervical screening programme.
• Review the process for gaining written consent so that this is consistently applied to minor surgical procedures.

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

This practice is rated as Requires Improvement overall. (Previous inspection January 2015 – The practice was rated as good in effective, caring, responsive and well-led as well as overall and requires improvement in safe. The practice was inspected in July 2015 to follow up on the breaches of regulation at the January 2015 inspection and they were rated as good in safe.)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

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 – Requires improvement.

People with long-term conditions – Requires improvement.

Families, children and young people – Requires improvement.

Working age people (including those recently retired and students – Requires improvement.

People whose circumstances may make them vulnerable – Requires improvement.

People experiencing poor mental health (including people with dementia) - Requires improvement.

We carried out an announced comprehensive inspection at Yorkleigh Surgery-CT on 6 March 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 but these did not always operate effectively.

• When incidents happened, the practice learned from them and improved their processes.

• Risks assessments and monitoring in relation to health and safety within the practice had not been appropriately undertaken.

• The temperature of fridges where vaccines were held had not been monitored consistently and there were no records of actions taken when the fridges operated outside of the recommended range.

• Patient Specific Directions for the administration of medicines were not produced in line with current guidelines.

• The practice was unable to demonstrate that specified information in relation to recruitment had been requested or retained.

• 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.

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

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

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

The areas where the provider must make improvements are:

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

• Ensure specified information is available regarding each person employed.

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

The areas where the provider should make improvements are:

• Review systems and processes to enable effective management oversight of staff training.

• Implement actions to improve the identification of carers.

• Review systems with regards to storage of policies so that they are easily accessible to all staff.

• Improve systems to enable oversight for the regular cleaning or change of fabric curtains.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out our inspection of Yorkleigh Surgery - CT on 23 July 2015 specifically to follow up on the findings of our last inspection carried out on 6 January 2015. The report for this inspection was published on 9 April 2015.

Overall we found the practice is rated as good with examples of safe medicines management practices and other aspects of safe patient treatment and support. Patients reported positive levels of satisfaction with the practice during our inspection.

Our key findings were as follows:

There were reliable systems, processes and practices in place to keep people safe and safeguarded from abuse for example;

• There were systems, processes and practices put in place and communicated to staff that were identified as essential to keep people safe. Staff were trained and made aware of these systems, processes and practices. The systems, processes and practices were monitored and improved when required.
• The arrangements for managing medicines in the practice kept patients safe; this included obtaining, prescribing, recording, handling, storing and security, dispensing, safe administration and disposal.
• Staff identified and responded to changing risks to patients who used the practice by monitoring them for deteriorating health and wellbeing and through the safe management of medicines and medical emergency equipment.
• Standards of cleanliness and hygiene were safely maintained and there were reliable systems in place to prevent and protect patients from a healthcare-associated infection.

We saw areas of outstanding practice including:

• The practice manager was a registered ‘Carers Champion’ for approximately 40 carers on the practices register and checked on their wellbeing and support needs.
• The practice was registered as a younger persons friendly practice and provided a young person’s drop in clinic each week for advice and support about sexual health issues. This service was open to all young people including those not registered at the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out our inspection on 6 January 2015. We inspected Yorkleigh Surgery as part of our new comprehensive inspection programme.

Overall we found the practice is rated as good. We saw examples of patient centred care provided by a safe, effective, caring, responsive and well led practice. Patients reported high levels of satisfaction with the practice during our inspection and this was reflected in the comment cards we also received.

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.
• Risks to patients were assessed and well managed, with the exception of those relating to medicines within GP bags.
• 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 about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. 100% of patients in the national GP survey had confidence and trust in the last GP they saw or spoke with.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw areas of outstanding practice including:

• The practice offered patients access to the ‘expert patient programme’ which supports patients with chronic illnesses to learn skills to self-manage their illness.
• The practice manager was a registered ‘Carers Champion’ for approximately 40 carers on the practices register and checked on their wellbeing and support needs.

The areas where the provider must make improvements are:

• Monitor medicines in GPs bags to ensure they are within expiry dates and ensure emergency equipment is discarded appropriately when past its use by date.

In addition the provider should:

• Review the effectiveness of the process for recording medicines, medicine stock checks and the removal of medical equipment which might otherwise be used.
• Ensure learning from complaints and significant events is systematically shared with staff and a clearer chronology of events is kept.
• Ensure minutes of all practice meetings are available to all staff.
• Ensure a record of infection control audits includes actions to be taken and clearer identification of areas that need refurbishing to further enhance the practice.
• Review its appraisal system in regard of training made available to staff.
• Review the process for retaining audits completed by GPs as part of their appraisal process for use as an educational resource for others in the practice.
• Review the process for supporting patients who did not have English as a first language.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice