The Care Quality Commission
  • Doctor
  • GP practice

Dr S Nelson & Partners Also known as Overton Park Surgery

Overall: Good read more about inspection ratings

Overton Park Road, Cheltenham, Gloucestershire, GL50 3BP (01242) 580511

Provided and run by:
Dr S Nelson & Partners

All Inspections

26 Aug 2020

During an inspection looking at part of the service

We previously carried out an announced focused inspection in July 2019 of Dr S Nelson & Partners following our annual review of the information available to us. This included information provided by the practice. At this inspection we focused on the effective and well led domains. We rated the practice as Good overall and Good for providing effective services but Requires Improvement for providing well led services as we found a breach of regulations. You can read the full report by selecting the ‘all reports’ link for Dr S Nelson & Partners on our website.

We were mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate. This was therefore a desk-based review. On 26 August 2020 we commenced the desk-based review to confirm the practice had carried out its plan to meet the legal requirements in relation to the breach of regulations that we identified in the July 2019 inspection. We also looked at progress made against the areas identified in our previous inspection where the practice should make improvements (but were not breaches of regulation).

We have found that the practice is now meeting those requirements and we have amended the rating for the practice accordingly. The practice is now rated as good for providing well led services.

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

  • What we found when we reviewed the information sent to us by the provider
  • Information from our ongoing monitoring of data about services and
  • Information from the provider.

We have rated the practice as Good for providing well-led services because:

  • The practice had improved their systems to monitor risks relating to Legionella.
  • Improvements had been made to the monitoring of non-medical prescribers.

The practice had also made developments in areas where we previously identified they should make improvements:

  • The practice had introduced systems to improve the recording of actions taken in response to risk assessments.
  • Assurance processes had been introduced to monitor how consent was recorded.
  • Additional measures had been introduced to try and improve cervical screening uptake.
  • The practice had improved processes to review children not brought to secondary care appointments

While there are no breaches in regulation, we did identify areas where the provider should make improvements;

  • Improve uptake for patients diagnosed with COPD who receive an annual assessment.
  • Continue to improve uptake of cervical screening.
  • Continue to review exception codes on patient records to ensure accuracy.

16 Jul 2019

During an inspection looking at part of the service

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change (either deterioration or improvement) to the quality of care provided since the last inspection.

This inspection focused on the following key questions:

  • Is the service Effective?
  • Is the service Well-led?

Because of the assurance received from our review of information we carried forward the ratings for the following key questions:

  • Is the service Safe?
  • Is the service Caring?
  • Is the service Responsive?

We have rated the practice as good overall.

We have rated the practice as good for providing effective services.

We found that;

  • Patients received effective care and treatment that met their needs.
  • Exception reporting for patients with respiratory conditions was higher than local and national averages.

We have rated the practice as requires improvements for patients with long-term conditions and good for all other population groups.

We have rated the practice as requires improvement for provider well led services.

We found that;

  • Systems and process to mitigate risk were not always effective.
  • Processes to ensure the competency of non-medical prescribers was not embedded.
  • There was not oversight of children who failed to attend for secondary care appointments.
  • Staff felt supported in their role.

The areas where the provider must make improvements are;

  • 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;

  • Ensure consent is obtained and recorded appropriately across the practice.
  • Improve the recording of when items requiring action from risk assessments had been completed.
  • Continue to improve uptake of cervical screening.

  • Ensure processes to review children not brought to secondary care appointments are embedded in practice.

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

Rosie Benneyworth

Chief Inspector of PMS and Integrated Care

17 February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S Nelson & Partners on 17 February 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • 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.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

  • The practice employed a community nurse who visited elderly patients, carried out reviews and liaised with other professionals to ensure older patients’ health and social needs were being met.

The areas where the provider should make improvement are:

  • Ensure there are robust and effective systems in place to ensure patients on high risk medicines or those who require regular monitoring are actively followed up in line with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice