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Inspection carried out on 5 December 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 30 November 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Friary House Surgery on 5 December 2017 as part of our planned 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.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 30 November 2016

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Friary House Surgery on 27 April 2016; overall the practice was rated as requires improvement. The practice had been rated as good for providing caring and effective services and requires improvement for providing safe, responsive and well-led services. This was because the practice had not embedded systems that kept patients safe and had not ensured effective governance arrangements monitored and improved quality of services provided to patients.

We undertook a focused follow up inspection on 30 November 2016 to look at the areas identified for improvement. We found the practice had taken appropriate action to ensure patients were kept safe and were listened to. The practice had embedded systems that monitored and improved quality of services provided to patients. The safe, responsive and well-led domains are now rated as good, with the overall practice being rated as good for all domains and population groups.

This report covers our findings in regard of the requirements and should be read in conjunction with the report published in October 2016. This can be done by selecting the 'all reports' link for Friary House Surgery on our website at www.cqc.org.uk .

At this inspection our key findings were:

  • 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. This included the monitoring of patients prescribed high risk medicines and the safe storage of vaccines.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. The provider demonstrated staff understood their roles and responsibilities according to policies and procedures. The practice had now embedded systems of good governance to monitor and improve the quality of services provided to patients.
  • The practice had completed a Disclosure and Barring check for all staff. Staff who were used as chaperones had completed relevant training to support them with this role.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns. The practice responded to complaints appropriately, all verbal complaints were recorded and subsequent learning shared with staff.
  • There was a clear leadership structure and staff stated they 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.

The areas where the provider should make improvement are:

  • Ensure patient access to services and appointments are reviewed and improved to support improvements in patient satisfaction.

  • Improve patient engagement such as through an active patient participation group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 27 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at The Friary House Surgery on 27 April 2016. Overall the practice is rated as requires improvement.

We found that improvements had been made since the previous inspection of June 2015 when the practice had been rated as inadequate and was placed into Special Measures.

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

  • The practice had put in place new policies and procedures to make improvements following the last inspection; some of the new arrangements were at an early stage and had not been fully embedded into the practice.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Patients said, although sometimes difficult to get through by telephone they had contact with a GP, 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 partners were keen to show the progress made and we saw that they had made improvements and been very engaged with the process.
  • Risks to patients were assessed and well managed, with the exception of those relating to infection control.

The areas where the provider must make improvements are:

  • Ensure that all staff undertaking chaperone duties have a DBS check or a risk assessment to ensure patient safety is fully considered.

  • Ensure more effective governance arrangements are put in place to monitor and improve the quality of services provided to patients.

  • Ensure systems are in place to monitor patients prescribed with high risk medicines prior to re-prescribing. Continue to monitor fridge temperatures to ensure medicines are stored safely and review staff awareness of medicines protocols in regard of vaccine storage.

  • Ensure patient access to services and appointments are reviewed and improved to support improvements in patient satisfaction.

In addition the provider should:

  • Review processes for clinical audits or quality improvement initiatives including staff awareness of infection control audits.

  • Review the management of verbal complaints as part of the overall complaints management process.

  • Review systems to identify record and support patients who are also carers.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 4 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 30 November 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Friary House Surgery on 5 December 2017 as part of our planned 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.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 23 September 2014

During an inspection to make sure that the improvements required had been made

We carried out this inspection in order to follow up on non compliance we had identified at the scheduled inspection carried out in September 2013. The non compliance related to the safeguarding of patients who use the service.

During our inspection of 23 September 2014 we found that significant improvements had been made and that the practice had achieved compliance regarding safeguarding.

Safeguarding training had been provided to all staff at the practice within the last twelve months. Relevant contact details and easy to follow guidance regarding safeguarding procedures were on display in staff areas. Safeguarding had been included as a regular agenda item at team meetings.

We spoke with four patients. All of them told us that they felt safe at the practice and that they had confidence in their GP and the practice staff.

The practice had responded to the findings of the previous CQC inspection report and had taken action to successfully achieve compliance.

Inspection carried out on 4 September 2013

During a routine inspection

We spoke with eleven patients who were pleased with the service they received from the practice. Patients told us they had been involved in the decisions made about their care. There was a recurring theme from all patients about the thorough care they received. One patient said "The treatment is excellent. They don’t leave anything to chance." Another patient said “They never fob you off.” We spoke with two parents who were both "pleased" with the care their families received.

We were told that staff treated people with respect and dignity. However information and facilities for some patients with disabilities and non English speakers could be improved.

None of the staff knew the correct local safeguarding procedures although all were confident they would find out and take appropriate action. Staff had attended safeguarding children training but not all had attended safeguarding adult training. The policies for safeguarding adults and children contained incorrect contact numbers.

Patients told us that they always felt safe in the care of the staff. There were appropriate arrangements in place which ensured that staff kept their knowledge and skills up to date. Staff spoke about the supportive environment and confirmed that they had access to adequate training.

The practice was organised and well led. There were effective systems in place to monitor the quality of the service provided and patients felt able to give feedback about the service they received.

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.