During a routine inspection

We carried out an announced comprehensive inspection at Dr N A Turner and partners on 04 February 2020 as part of our inspection programme.

At this inspection we followed up on a breach of regulations identified at a previous inspection on 08 January 2019 rated requires improvement overall. Regulation 17 HSCA (RA) Regulations 2014 Good Governance was not being met because: The registered provider had not improved patient satisfaction identified in the national GP patient survey of 2018.

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

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for safe, effective, caring and well-led services, and requires improvement for responsive services.

We have rated the practice as requires improvement for responsive because patient survey data, as reported in the national GP patient survey, was below local and national averages. This affects all population groups so they have also been rated as requires improvement.

We found that:

• The practice provided care that kept patients safe, and protected them from avoidable harm.
• A system to manage medicine safety alerts and disseminate them through the practice was seen. Staff showed us how information from alerts was acted on and seen by the relevant staff.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Patient satisfaction was a continuous focus at the practice with a programme of work achieved over the last year to improve and gather patient views.
• We found staff records were well managed and appraisals provided annually.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• Staff told us the GPs and management were visible and approachable within the practice.

Whilst we found no breaches of regulations, the provider should:

• Continue to improve patient satisfaction in the national GP patient survey.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

During a routine inspection

We carried out an announced comprehensive inspection at Dr N A Turner and partners, otherwise know as ‘Tiptree Medical Centre’ on 08 January 2019 as part of our inspection programme.

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

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

We have rated the practice as requires improvement for providing caring services because;

• Data from the national GP survey reflected that patients were not satisfied with the services provided.

We have rated the practice as requires improvement for providing responsive services because;

• Data from the national GP survey reflected that patients were not satisfied with the services provided. As this affects all population groups we also rated them as requires improvement.

We have rated the practice as good for providing safe, effective and well-led services because;

• 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 provided care in a way that kept patients safe and protected them from preventable harm.
• Patients received effective care and treatment that met their needs.
• The practice listened to their patients and organised and delivered services to meet patients’ needs. This included in-house services normally delivered in secondary and community settings due to the practice rural location.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
• Leaders had the capacity and skills to deliver high-quality, sustainable care.
• Staff told us they felt supported, valued and that management listened to their opinions.
• There was a focus on continuous learning and improvement at most levels of the organisation.

The area where the provider must make improvement is;

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The area where the provider should make improvement is;

• Improve the identification of carers to enable this group of patients to access the care and support they need.

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

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

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N A Turner & Partners, also known as Tiptree Medical Centre on 27 September 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. However, the practice’s Control of Substances Hazardous to Health risk assessment did not include all hazardous substances held at the practice.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice adhered to the accessible information standard, which supported patients with disability impairment or sensory loss to be involved in their care.
• The practice had been accredited as a dementia friendly practice. This involved training staff as to how to support patients with dementia and their families, and seeking to ensure that the practice was accessible to those who may be living with dementia.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Services at the practice included audiology, podiatry, urology, abdominal aortic aneurysm (AAA) screening, a Dementia advisor, midwife and Health in Mind (IAPT).
• Data from the national GP patient survey showed patients rated the practice in line with or slightly lower than others for several aspects of care. Action had been taken since the survey with a view to improve outcomes.
• Information about services and how to complain was available and easy to understand. The practice was committed to seeking and partaking in pilot schemes to improve patient care.
• 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 areas where the provider should make improvement are:

• Ensure the Control of Substances Hazardous to Health includes all hazardous substances stored at the practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During a routine inspection

Tiptree Medical Centre provides primary medical services for approximately 11,000 patients living in Tiptree and the surrounding area.

The regulated activities we inspected were: diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

We found that there were systems in place to ensure patient safety. These included a business contingency plan in the event of a non-clinical emergency, structures for handling clinical emergencies, a clear medicines management system and, robust child and adult safeguarding processes.

The practice made use of best practice guidelines, learning from significant events analysis and national bench marking systems to provide effective care. They also developed systems, such as, monitoring uptake of child vaccinations and health promotion activities to improve patient outcomes and mitigate risks.

Most patients we spoke with felt involved in the treatment process and thought that staff had a good attitude. We saw reception staff dealing with difficult situations with empathy and respect.

There could be more robust systems in place to identify those patients who are also carers and to consider the impact that their medical history/treatment will have on them and those they care for.

We found that the practice was aware of the needs of the different population groups and tried to ensure that all population groups had equal access to services provided. However written information was not easily available in a variety of formats which may affect access for some groups of patients.

There were issues both historically and currently with access to appointments. However the practice had worked hard to try to resolve these and was able to show that changes they had made had positive outcomes for patients.

There was an audit structure in place but this could be more robust.

Patients and staff were able to raise concerns or make suggestions and we saw that these were investigated and action taken.