Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection the Beaumont Practice on 30 November 2017, which was undertaken in accordance with our published process to re-inspect a proportion of practices previously rated as good or outstanding. At the previous inspection in April 2015 the practice had been rated as Good. The practice is now rated as requires improvement overall and the five key questions are rated as follows:
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. We have rated the practice as requires improvement overall and for the key questions of safe and well-led. The concerns which led to these ratings apply to everyone using the service. Accordingly, the population groups are rated as follows:
Older People – Requires improvement
People with long-term conditions – Requires improvement
Families, children and young people – Requires improvement
Working age people (including those 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
At this inspection we found:
- The remaining GP partner had found running the practice alone to be challenging. We had concerns that the GP partner working elsewhere for part of the week might adversely impact on clinical and managerial oversight at the practice. However, a new prospective partner has now been identified and they will shortly be joining the practice. It was anticipated that their appointment would strengthen the leadership capacity, oversight and governance.
- There had been some uncertainty over the frequency of refresher training for staff, but it was confirmed during the inspection that some staff members were not up to date with their mandatory training needs.
- Although the clinical team met frequently, this was not on a formal basis and there was not consistent recording to ensure that relevant information was passed on.
- The practice learned from incidents and took action to improve its processes. However, the relevant protocol was in need of review and records of discussions were not consistently kept or passed on.
- Published data showed the practice performance was above local and national averages.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence-based guidelines.
- There was some evidence that clinical audit drove improvement. However, there was scope for more audits to be carried out.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found it easy to use the appointment system and told us they could access care when they needed it.
- Data from the GP patient survey showed that patient satisfaction had been below local and national averages. However, this had been acted upon by the practice and its own larger and more recent patient survey had shown improvements had been made.
The areas where the practice must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients.
- Ensure there are effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
In addition, the areas where the practice should make improvements are:
- Produce and implement a practice protocol covering guidelines issued by the National Institute for Health and Care Excellence (NICE).
- Implement a more extensive system of clinical auditing.
- Establish weekly minuted clinical meetings to ensure that information is appropriately recorded and shared.
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Continue with efforts to address the cleanliness concerns relating to one of the consultation rooms.
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Continue to review and monitor patients’ feedback to maintain the improvement in satisfaction levels.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice