Updated 19 June 2018

This practice is rated as Good overall. (Previous inspection December 2014 – Good)

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? - Good

We carried out an announced comprehensive inspection at The Culverhay Surgery on 10 April 2018 as part of our inspection programme.

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.
• 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.
• Feedback from patients and the patient participation group was positive regarding the quality of care experienced at the practice.
• The practice had undertaken an Equality Impact Assessment (EIA) on its recruitment processes to ensure the values of equality and diversity were maintained when undertaking recruitment.
• The premises had undergone significant refurbishment which had improved the facilities and created space for additional consulting rooms.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We found an area of Outstanding Practice:

• GPs at the practice undertook bi-annual joint visits with a local Consultant in Psychiatry for old age people where each person living in a care or nursing home was reviewed.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Formalise processes in the dispensary so that medicines check, including controlled drugs and near misses are recorded.
• Review access arrangements so that only authorised staff have access to the controlled drugs keys.

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

Updated 19 June 2018

We rated the practice as requires improvement for providing safe services.

Safety systems and processes

The practice had clear systems to keep people safe and safeguarded from abuse.

• The practice had appropriate systems to safeguard children and vulnerable adults from abuse. All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns. Reports and learning from safeguarding incidents were available to staff. Staff who acted as chaperones were trained for their role and had received a DBS check. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.)
• Staff took steps, including working with other agencies, to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect.
• The practice carried out appropriate staff checks at the time of recruitment and on an ongoing basis.
• There was an effective system to manage infection prevention and control.
• The practice had arrangements to ensure that facilities and equipment were safe and in good working order.
• Arrangements for managing waste and clinical specimens kept people safe.

Risks to patients

There were adequate systems to assess, monitor and manage risks to patient safety.

• Arrangements were in place for planning and monitoring the number and mix of staff needed to meet patients’ needs, including planning for holidays, sickness, busy periods and epidemics.
• There was an effective induction system for temporary staff tailored to their role.
• The practice was equipped to deal with medical emergencies and staff were suitably trained in emergency procedures.
• Staff understood their responsibilities to manage emergencies on the premises and to recognise those in need of urgent medical attention. Clinicians knew how to identify and manage patients with severe infections including sepsis. However, we found that reception staff did not have information regarding ‘red flag’ sepsis symptoms that might be reported by patients and how to respond. We were told that reception staff would put calls through to a GP if an unwell patient telephoned the practice or would seek immediate assistance from a clinician if a patient became unwell in the waiting area. The practice took action on the day of the inspection and made information and guidance available to reception staff to support them to take the appropriate action. This was also displayed on the information screen in the waiting area.
• When there were changes to services or staff the practice assessed and monitored the impact on safety. For example, during recent renovation work, the practice had assessed the risks to the service they delivered and implemented risk reduction actions to maintain the safety of patients and staff.

Information to deliver safe care and treatment

Staff had the information they needed to deliver safe care and treatment to patients.

• The care records we saw showed that information needed to deliver safe care and treatment was available to staff. There was a documented approach to managing test results.
• The practice had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.
• Clinicians made timely referrals in line with protocols.

Appropriate and safe use of medicines

The practice had systems for appropriate and safe handling of medicines.

• Staff prescribed, administered or supplied medicines to patients and gave advice on medicines in line with current national guidance. The practice had reviewed its antibiotic prescribing and taken action to support good antimicrobial stewardship in line with local and national guidance.
• Patients’ health was monitored in relation to the use of medicines and followed up on appropriately. Patients were involved in regular reviews of their medicines.

Arrangements for dispensing medicines at the practice did not always keep patients safe. Following our inspection, the practice had implemented changes and sent us evidence that the issues identified had been rectified so risks to patients were low.

• Some controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse) were being given to patients before a doctor signed the prescription for acute conditions. Following the inspection, the practice sent us information to demonstrate that they had amended their Standard Operating Procedure (SOP) so that all prescriptions for controlled drugs would be signed before dispensing.
• Controlled drugs were stored securely however, access was not restricted to appropriate individuals. Following the inspection, the practice told us changes had been made to the storage of the controlled drug cabinet keys to ensure that access is restricted to authorised staff.
• We were told that expiry dates for medicines in the dispensary were checked but there were no records in place to support this. The procedure for date checking has since been reviewed and the records were now available.
• Dispensing errors that reached patients were recorded and investigated but the dispensary did not have a process to record near-miss errors. Following the inspection, the practice told us procedures have been updated to ensure near misses are recorded and reviewed to minimise the chances of similar errors occurring again.
• Staff monitored fridge temperatures daily to make sure they were in the right range for storage of some medicines. However, the records showed that it had previously been higher than the recommended range and there was no evidence that actions had been taken. No vaccines were stored in this fridge. The practice sent us information after the inspection to demonstrate they had amended their SOP so that actions were taken and recorded in the event that the temperature was outside of the normal range.
• The systems for managing medicines, including vaccines, medical gases, and emergency medicines and equipment did not always minimise risks. Emergency medicines were held in a secure area and were easily accessible to staff. There was a record of expiry dates for medicines, however on the day of inspection we found two medicines which had expired but had not been removed from the stock. Following the inspection, the practice told us it had reviewed its procedure for checking the emergency medicines and introduced a tamper evident seal.

Track record on safety

The practice had a good track record on safety.

• There were comprehensive risk assessments in relation to safety issues.
• The practice monitored and reviewed activity. This helped it to understand risks and gave a clear, accurate and current picture of safety that led to safety improvements.

Lessons learned and improvements made

The practice learned and made improvements when things went wrong.

• Staff understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so.
• There were adequate systems for reviewing and investigating when things went wrong. The practice learned and shared lessons, identified themes and took action to improve safety in the practice. However, we noted that near misses in the dispensary were not recorded. The practice sent us information following the inspection to demonstrate that a log to record near misses had been implemented to ensure all staff recorded near misses and that these were discussed at meetings to identify learning.
• The practice acted on and learned from external safety events as well as patient and medicine safety alerts.

Please refer to the Evidence Tables for further information.

Updated 19 June 2018

We rated the practice and all of the population groups as good for providing effective services overall except for older people population which we rated as Outstanding.

(Please note: Any Quality Outcomes (QOF) data relates to 2016/17. QOF is a system intended to improve the quality of general practice and reward good practice.)

Effective needs assessment, care and treatment

The practice had systems to keep clinicians up to date with current evidence-based practice. We saw that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols.

• Patients’ immediate and ongoing needs were fully assessed. This included their clinical needs and their mental and physical wellbeing.
• We saw no evidence of discrimination when making care and treatment decisions.
• The practice used their clinical systems to identify patients on specific treatment and to check whether those patients received care in line with best practice guidance.
• Staff used appropriate tools to assess the level of pain in patients.
• Staff advised patients what to do if their condition got worse and where to seek further help and support.

Older people:

We rated this population group as outstanding.

• Older patients who are frail or may be vulnerable received a full assessment of their physical, mental and social needs. The practice used an appropriate tool to identify patients aged 65 and over who were living with moderate or severe frailty. Those identified as being frail had a clinical review including a review of medication.
• Patients aged over 75 were invited for a health check. If necessary they were referred to other services such as voluntary services and supported by an appropriate care plan.
• The practice followed up on older patients discharged from hospital. It ensured that their care plans and prescriptions were updated to reflect any extra or changed needs.
• Staff had appropriate knowledge of treating older people including their psychological, mental and communication needs.
• The practice worked with a clinical pharmacist to undertake annual medicines reviews of older patients living in nursing or care homes. GPs at the practice undertook bi-annual joint visits with a local Consultant in Psychiatry for old age people where each person living in a care or nursing home was reviewed.
• The practice held monthly meetings with community teams to discuss and review older patients who may also be vulnerable.

People with long-term conditions:

We rated this population group as good.

• Patients with long-term conditions had a structured annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GP worked with other health and care professionals to deliver a coordinated package of care.
• Staff who were responsible for reviews of patients with long term conditions had received specific training.
• GPs followed up patients who had received treatment in hospital or through out of hours services for an acute exacerbation of asthma.
• The practice had arrangements for adults with newly diagnosed cardiovascular disease including the offer of statins for secondary prevention, people with suspected hypertension were offered ambulatory blood pressure monitoring and patients with atrial fibrillation were assessed for stroke risk and treated as appropriate.
• The practice was able to demonstrate how they identified patients with commonly undiagnosed conditions, for example diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation and hypertension)

Families, children and young people:

We rated this population group as good.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were in line or above the target percentage of 90%.

• The practice had arrangements to identify and review the treatment of newly pregnant women on long-term medicines. These patients were provided with advice and post-natal support in accordance with best practice guidance.
• The practice had arrangements for following up failed attendance of children’s appointments following an appointment in secondary care or for immunisation. There was a dedicated member of the administration team who contacted parents or guardians of children who failed to attend appointments.

Working age people (including those recently retired and students):

We rated this population group as good.

• The practice’s uptake for cervical screening was 81%%, which was in line with the 80% coverage target for the national screening programme.
• The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The patient uptake for this service in the last two and a half years was 67%, compared to the CCG average of 62% and national average of 55%. The practice also encouraged eligible female patients to attend for breast cancer screening. The rate of uptake of this screening programme in the last three years was 82%, compared to the CCG average of 75% and national average of 70%.
• The practice had systems to inform eligible patients to have the meningitis vaccine, for example before attending university for the first time.
• Patients had access to appropriate health assessments and checks including NHS checks for patients aged 40-74. There was appropriate follow-up on the outcome of health assessments and checks where abnormalities or risk factors were identified.

People whose circumstances make them vulnerable:

We rated this population group as good.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice had a system for vaccinating patients with an underlying medical condition according to the recommended schedule.
• The practice worked with specialist services in Gloucestershire and South Gloucestershire to support patients with substance misuse problems.
• One of the practice nurses was also a care co-ordinator and engaged with patients who were vulnerable and offered referral to other organisations such as Red Cross and Age Concern, and offered frequent telephone support.

People experiencing poor mental health (including people with dementia):

We rated this population group as good.

• The practice assessed and monitored the physical health of people with mental illness, severe mental illness, and personality disorder by providing access to health checks, interventions for physical activity, obesity, diabetes, heart disease, cancer and access to ‘stop smoking’ services. There was a system for following up patients who failed to attend for administration of long term medication.
• When patients were assessed to be at risk of suicide or self-harm the practice had arrangements in place to help them to remain safe.
• 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months (04/2016 to 03/2017). This was comparable to the CCG average of 87% and national average of 84%. Practice data which had not yet been externally verified showed that 79% of patients with dementia had a review during the year ending 31 March 2018.
• 91% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the previous 12 months. This was comparable to the CCG average of 94% and national average of 90%.
• The practice specifically considered the physical health needs of patients with poor mental health and those living with dementia. For example, 90% of patients experiencing poor mental health had received discussion and advice about alcohol consumption. This was comparable to the CCG average of 93% and national average of 91%.
• Patients at risk of dementia were identified and offered an assessment to detect possible signs of dementia. When dementia was suspected there was an appropriate referral for diagnosis.
• The practice offered annual health checks to patients with a learning disability.

Monitoring care and treatment

The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. For example, following an alert from the Medicines and Healthcare products Regulatory Agency (MHRA) highlighting risks with the use of a medicine normally prescribed for increasing the movements or contractions of the stomach and bowel as well as treating symptoms of nausea and vomiting, the practice undertook an audit of patients who were currently taking this medicine. The first audit in January 2015 identified 16 patients were taking this medicine. Each patient was reviewed by a GP and actions were taken to discontinue patients on this medicine where appropriate. Patients with exceptional circumstances, such as those with complex medical needs and on palliative care were deemed appropriate to continue with this medicine. Awareness was raised amongst clinicians about the effects of this medicine for short-term and long term use. A re-audit in August 2017 showed that seven patients were on this medicine and each case was reviewed. A further audit in January 2018 showed that one patient was on this medicine and a review of the result showed that the medicine had been appropriately prescribed.

The most recent published QOF results showed the practice had achieved 99% of the total number of points available compared with the clinical commissioning group (CCG) average of 98% and national average of 96%. The overall exception reporting rate at the practice was 7% compared with the CCG average of 6% and national average of 6%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate.)

• The practice used information about care and treatment to make improvements.
• The practice was actively involved in quality improvement activity. Where appropriate, clinicians took part in local and national improvement initiatives.

Effective staffing

Staff had the skills, knowledge and experience to carry out their roles.

• Staff had appropriate knowledge for their role, for example, to carry out reviews for people with long term conditions, older people and people requiring contraceptive reviews.
• Staff whose role included immunisation and taking samples for the cervical screening programme had received specific training and could demonstrate how they stayed up to date.
• The practice understood the learning needs of staff and provided protected time and training to meet them. Up to date records of skills, qualifications and training were maintained. Staff were encouraged and given opportunities to develop.
• The practice provided staff with ongoing support. This included an induction process, one-to-one meetings, appraisals, coaching and mentoring, clinical supervision and support for revalidation. The induction process for healthcare assistants included the requirements of the Care Certificate. The practice ensured the competence of staff employed in advanced roles by audit of their clinical decision making, including non-medical prescribing.
• There was a clear approach for supporting and managing staff when their performance was poor or variable.
• Dispensary staff were appropriately qualified and their competence was assessed annually. They could demonstrate how they kept up to date.

Coordinating care and treatment

Staff worked together and with other health and social care professionals to deliver effective care and treatment.

• We saw records that showed that all appropriate staff, including those in different teams and organisations, were involved in assessing, planning and delivering care and treatment.
• The practice shared clear and accurate information with relevant professionals when deciding care delivery for people with long term conditions and when coordinating healthcare for care home residents. They shared information with, and liaised, with community services, social services and carers for housebound patients and with health visitors and community services for children who have relocated into the local area.
• Patients received coordinated and person-centred care. This included when they moved between services, when they were referred, or after they were discharged from hospital. The practice worked with patients to develop personal care plans that were shared with relevant agencies.
• The practice ensured that end of life care was delivered in a coordinated way which took into account the needs of different patients, including those who may be vulnerable because of their circumstances.

Helping patients to live healthier lives

Staff were consistent and proactive in helping patients to live healthier lives.

• The practice identified patients who may be in need of extra support and directed them to relevant services. This included patients in the last 12 months of their lives, patients at risk of developing a long-term condition and carers. One of the practice nurses was also a care co-ordinator and engaged with patients who were vulnerable and offered referral to other organisations such as Red Cross and Age Concern, and offered frequent telephone support.
• Staff encouraged and supported patients to be involved in monitoring and managing their own health, for example through social prescribing schemes.
• Staff discussed changes to care or treatment with patients and their carers as necessary.
• The practice supported national priorities and initiatives to improve the population’s health, for example, stop smoking campaigns, tackling obesity.

Consent to care and treatment

The practice obtained consent to care and treatment in line with legislation and guidance.

• Clinicians understood the requirements of legislation and guidance when considering consent and decision making.
• Clinicians supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.
• The practice monitored the process for seeking consent appropriately.

Please refer to the Evidence Tables for further information.

Updated 19 June 2018

We rated the practice as good for caring.

Kindness, respect and compassion

Staff treated patients with kindness, respect and compassion.

• Feedback from patients was positive about the way staff treat people.
• Staff understood patients’ personal, cultural, social and religious needs.
• The practice gave patients timely support and information.
• Patients we spoke with on the day of the inspection told us they were treated with kindness, respect and compassion.

Involvement in decisions about care and treatment

Staff helped patients to be involved in decisions about care and treatment. They were aware of the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information that they are given.)

• Staff communicated with people in a way that they could understand, for example, communication aids and easy read materials were available.
• Staff helped patients and their carers find further information and access community and advocacy services. They helped them ask questions about their care and treatment.
• The practice proactively identified carers and supported them.

Privacy and dignity

The practice respected patients’ privacy and dignity.

• Reception staff knew that if patients wanted to discuss sensitive issues or appeared distressed they could offer them a private room to discuss their needs. The practice had specifically considered the availability of a private room for patients to be able to discuss sensitive issues when renovating the premises.
• Staff recognised the importance of people’s dignity and respect. They challenged behaviour that fell short of this. For example, the practice had policies and procedures in place to address behaviours which did not promote dignity and respect to patients.

Please refer to the Evidence Tables for further information.

Updated 19 June 2018

We rated the practice, and all of the population groups, as good for providing responsive services

.

Responding to and meeting people’s needs

The practice organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

• The practice understood the needs of its population and tailored services in response to those needs.
• Telephone consultations were available which supported patients who were unable to attend the practice during normal working hours.
• The facilities and premises were appropriate for the services delivered. The practice had recently undergone significant refurbishment to improve the facilities and premises for patients and staff.
• The practice made reasonable adjustments when patients found it hard to access services. For example, whilst undergoing refurbishment, the practice built a temporary ramp so that patients who used a wheelchair could still access the premises.
• The practice provided effective care coordination for patients who were more vulnerable or who have complex needs. They supported them to access services both within and outside the practice.
• Care and treatment for patients with multiple long-term conditions and patients approaching the end of life was coordinated with other services.
• The practice provided dispensary services for people who needed additional support with their medicines, for example a remote collection service, weekly or monthly blister packs, and large print labels.

Older people:

• All patients had a named GP who supported them in whatever setting they lived, whether it was at home or in a care home or supported living scheme.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The GP and practice nurse also accommodated home visits for those who had difficulties getting to the practice due to limited local public transport availability.
• Patients living in nursing or care homes were offered influenza (flu) vaccines. Practice data showed that 81% of patients living in a nursing or care home had received a flu vaccine as at January 2018.

People with long-term conditions:

• Patients with a long-term condition received an annual review to check their health and medicines needs were being appropriately met.
• The practice held regular meetings with the local district nursing team to discuss and manage the needs of patients with complex medical issues.
• The practice could offer patients options such as weight management programmes and exercise on prescription for patients who found this beneficial.

Families, children and young people:

• We found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances. Records we looked at confirmed this.
• All parents or guardians calling with concerns about a child under the age of 18 were offered a same day appointment when necessary.

Working age people (including those recently retired and students):

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended opening hours and Saturday morning appointments between December and March.
• The practice worked with the patient participation group to promote online services such as repeat prescription ordering and booking appointment.

People whose circumstances make them vulnerable:

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• People in vulnerable circumstances were easily able to register with the practice, including those with no fixed abode.

People experiencing poor mental health (including people with dementia):

• Staff interviewed had a good understanding of how to support patients with mental health needs and those patients living with dementia.
• The practice held GP led dedicated monthly mental health and dementia clinics. Patients who failed to attend were proactively followed up by a phone call from a GP.

Timely access to care and treatment

Patients were able to access care and treatment from the practice within an acceptable timescale for their needs. The practice had a policy to see all patients who needed an appointment on the day. Patients we spoke with on the day of the inspection confirmed this.

• Patients had timely access to initial assessment, test results, diagnosis and treatment.
• Waiting times, delays and cancellations were minimal and managed appropriately.
• Patients with the most urgent needs had their care and treatment prioritised.
• Patients reported that the appointment system was easy to use.
• The National GP Survey results showed that the practice was performing significantly better for patients’ access to care and treatment compared to local and national averages.

Listening and learning from concerns and complaints

The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.

• Information about how to make a complaint or raise concerns was available. Staff treated patients who made complaints compassionately.
• The complaint policy and procedures were in line with recognised guidance. The practice learned lessons from individual concerns and complaints and also from analysis of trends. It acted as a result to improve the quality of care.

Please refer to the Evidence Tables for further information.

Updated 19 June 2018

We rated the practice and all of the population groups as good for providing a well-led service.

Leadership capacity and capability

Leaders had the capacity and skills to deliver high-quality, sustainable care.

• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
• Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership.
• The practice had effective processes to develop leadership capacity and skills, including planning for the future leadership of the practice.

Vision and strategy

The practice had a clear vision and credible strategy to deliver high quality, sustainable care.

• There was a clear vision and set of values. The practice had a realistic strategy and supporting business plans to achieve priorities. The practice developed its vision, values and strategy jointly with patients, staff and external partners.
• Staff were aware of and understood the vision, values and strategy and their role in achieving them.
• The strategy was in line with health and social priorities across the region. The practice planned its services to meet the needs of the practice population. They had considered the likely impact of new houses being built locally and had created additional consulting rooms to meet the expected increase in demand.
• The practice monitored progress against delivery of the strategy.

Culture

The practice had a culture of high-quality sustainable care.

• Staff stated they felt respected, supported and valued. They were proud to work in the practice.
• The practice focused on the needs of patients.
• Leaders and managers acted on behaviour and performance inconsistent with the vision and values.
• Openness, honesty and transparency were demonstrated when responding to incidents and complaints. The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

• Staff we spoke with told us they were able to raise concerns and were encouraged to do so. They had confidence that these would be addressed.
• There were processes for providing all staff with the development they need. This included appraisal and career development conversations. All staff received regular annual appraisals in the last year. Staff were supported to meet the requirements of professional revalidation where necessary.
• Clinical staff were considered valued members of the practice team. They were given protected time for professional development and evaluation of their clinical work.
• There was a strong emphasis on the safety and well-being of all staff.
• The practice actively promoted equality and diversity. Staff had received equality and diversity training. Staff felt they were treated equally.
• There were positive relationships between staff and teams.

Governance arrangements

There were clear responsibilities, roles and systems of accountability to support good governance and management.

• Structures, processes and systems to support good governance and management were clearly set out, understood and effective. The governance and management of partnerships, joint working arrangements and shared services promoted interactive and co-ordinated person-centred care.
• Staff were clear on their roles and accountabilities including in respect of safeguarding and infection prevention and control
• Practice leaders had established proper policies, procedures and activities to ensure safety and assured themselves that they were operating as intended.

Managing risks, issues and performance

There were clear and effective processes for managing risks, issues and performance.

• There was an effective, process to identify, understand, monitor and address current and future risks including risks to patient safety. For example, risks to patients and staff had been assessed for each stage of the refurbishment of the premises and the practice manager kept oversight of these at each stage and liaised with the contractors to ensure these were adhered to.
• The practice had processes to manage current and future performance. Performance of employed clinical staff could be demonstrated through audit of their consultations, prescribing and referral decisions. Practice leaders had oversight of national and local safety alerts, incidents, and complaints.
• Clinical audit had a positive impact on quality of care and outcomes for patients. There was clear evidence of action to change practice to improve quality.
• The practice had plans in place and had trained staff for major incidents.
• The practice implemented service developments and where efficiency changes were made this was with input from clinicians to understand their impact on the quality of care.

Appropriate and accurate information

The practice acted on appropriate and accurate information.

• Quality and operational information was used to ensure and improve performance. Performance information was combined with the views of patients.
• Quality and sustainability were discussed in relevant meetings where all staff had sufficient access to information.
• The practice used performance information which was reported and monitored and management and staff were held to account.
• The information used to monitor performance and the delivery of quality care was accurate and useful. There were plans to address any identified weaknesses.
• The practice used information technology systems to monitor and improve the quality of care.
• The practice submitted data or notifications to external organisations as required.
• There were robust arrangements in line with data security standards for the availability, integrity and confidentiality of patient identifiable data, records and data management systems.

Engagement with patients, the public, staff and external partners

The practice involved patients, the public, staff and external partners to support high-quality sustainable services.

• A full and diverse range of patients’, staff and external partners’ views and concerns were encouraged, heard and acted on to shape services and culture. There was an active patient participation group.
• The service was transparent, collaborative and open with stakeholders about performance.

Continuous improvement and innovation

There were evidence of systems and processes for learning, continuous improvement and innovation.

• There was a focus on continuous learning and improvement.
• Staff knew about improvement methods and had the skills to use them.
• The practice made use of internal and external reviews of incidents and complaints. Learning was shared and used to make improvements.
• Leaders and managers encouraged staff to take time out to review individual and team objectives, processes and performance.

Please refer to the Evidence Tables for further information.

Updated 19 June 2018

Updated 19 June 2018

Updated 19 June 2018

Updated 19 June 2018

Updated 19 June 2018

Updated 19 June 2018