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Reports


Review carried out on 9 January 2020

During an annual regulatory review

We reviewed the information available to us about The Family Practice on 9 January 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 03 October to 03 October 2018

During a routine inspection

This practice is rated as Good overall. (Previous rating March 2017 – Good)

The key questions at this inspection are 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 The Family Practice on 3 October 2018. A previous inspection in July 2016 had rated the practice as inadequate overall and placed it into special measures. When we re-inspected the practice in March 2017 we found improvements had been made and the rating was updated to good overall. This most recent inspection was carried out to ensure that the improvements implemented by the practice had been sustained. The previous reports from the July 2016 and March 2017 inspections can be found by selecting the ‘all reports’ link for The Family Practice on our website at www.cqc.org.uk.

At this inspection we found:

  • The practice had clear 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. Where appropriate, we saw this learning was shared with external stakeholders.
  • 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. Patients recognised the improvements the practice had made around access to appointments over the previous two years.
  • Staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice worked to maximise care delivered to vulnerable groups. For example it had established close links with the local Salvation Army and was hoping to be part of a pilot project to improve care to this patient cohort once the proposal had been ratified by the Clinical Commissioning Group (CCG).
  • There was a clear staffing structure and staff were aware of their roles and responsibilities.
  • The practice was proactive in identifying and supporting carers; a member of staff took the lead on this and networked with local carer support organisations to ensure patients accessed appropriate help.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Consider methods to raise awareness of safety alerts received and action taken as a result throughout the clinical team.

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

Please refer to the detailed report and the evidence tables for further information.

Inspection carried out on 16 March 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Family Practice on 6 July 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The concerns identified included significant gaps in the practice’s governance arrangements and recruitment processes. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for The Family Practice on our website at www.cqc.org.uk.

This follow up inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 16 March 2017. We found that the practice had made improvements and that it was meeting the required regulations. Overall the practice is now rated as good.

Our key findings were as follows:

  • We found the governance arrangements in place had significantly improved and the leadership structure had been simplified and was better understood.

  • Staff were aware of how to report incidents and concerns. We saw that incidents were investigated thoroughly and learning disseminated.

  • A more systematic approach to documenting work undertaken around the analysis of significant events had been implemented, which facilitated ongoing review of any changes made and analysis of trends.

  • Recruitment processes were now more thorough and included all required pre-employment checks.

  • A systematic approach to undertaking and reviewing quality improvement work had been implemented within the practice which included the completion of clinical audits.

  • Staff were aware of current evidence based guidance. There had also been improvements made in the management of staff training. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

  • The practice was able to demonstrate its understanding of its population profile and had used this understanding to meet the needs of its population.

  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

  • Patients we spoke with said they found it easy to make an appointment with a GP and there had been improvements in continuity of care, with urgent appointments available the same day.
  • Staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

There were some areas of practice where the provider should make improvements:

  • Ensure that ongoing assessment, monitoring and improvement of the quality of services provided is undertaken.

  • Ensure work continues around updating practice policy documents to make sure all are practice specific and contain up to date information that is relevant to the practice.

  • The practice website should accurately reflect the practice’s opening times with respect of extended hours appointments to ensure patients are aware of this facility.

  • Consider longer term objectives as part of the practice’s documented business plan.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 06/07/2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Family Practice on 6/7/2016. Overall the practice is rated as inadequate.

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

  • Staff were aware of how to report incidents and concerns. We saw that incidents were investigated and learning disseminated. However, near misses were not documented so learning was not always maximised.

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment.

  • There was no evidence that staff were up to date in training to administer vaccines. Appropriate patient specific directions were not in place to ensure vaccinations were administered in line with legislation.

  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity. However, patients also felt frustrated by the lack of continuity of care available.

  • The practice had insufficient leadership and inadequate governance arrangements.

The areas where the provider must make improvements are:

  • Ensure recruitment arrangements include all necessary employment checks for all staff.

  • Ensure a quality improvement programme is implemented which may include clinical audits to ensure improvements to care and treatment have been achieved.

  • Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

  • Provide staff with policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

  • Ensure there is leadership to deliver all improvements.

  • Ensure infection prevention and control is appropriately monitored.

  • Ensure staff training is undertaken and appropriately managed to ensure all staff have the skills and qualifications to carry out their roles.

  • Ensure an appropriate complaints process is implemented and that complainants receive appropriate guidance about how to escalate their concerns should they wish. Measures should be put in place to ensure learning from complaints is maximised and disseminated appropriately amongst staff.

  • Ensure measures are taken to gain feedback from patients.

The areas where the provider should make improvement are:

  • Consider lowering the threshold for formal analysis of significant events and near misses in order to maximise learning outcomes.
  • A systematic approach should be applied to documenting the management of safety alerts within the practice to ensure a clear audit trail of whom they have been disseminated to and any actions taken as a result.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice