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Inspection carried out on 24 May 2019

During a routine inspection

We carried out an announced comprehensive inspection at The Forest Practice 24 June 2019 to follow up on breaches of regulations. CQC inspected the service on 1 May 2018 and asked the provider to make improvements regarding breach of Regulation 17 (Good governance) and Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We checked these areas as part of this comprehensive inspection and found all of the previous concerns had been resolved, but some new concerns under Regulation 17 (Good governance) Health and Social Care Act 2008 were identified.

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 all population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Systems to assess, monitor and manage risks to patient safety were generally effective.
  • 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.
  • The practice had a clear vision and positive working culture, some systems had weaknesses that staff immediately remedied, including safety alerts and elements of recruitment or induction for some staff.

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

  • Review and improve systems to ensure care and treatment is provided in a safe way to patients, including staff’s early recognition of signs and symptoms of sepsis.
  • Review the recruitment and induction process, such as to ensure locums clinicians induction, working agreements, and occupational health considerations are embedded and formalised.
  • Review and improve arrangements systems to ensure management staff and staff at all levels receive appropriate dementia awareness training.
  • Review and improve systems for safety alerts.
  • Review and evaluate systems to ensure patients see the most appropriate clinician without delay.

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

Inspection carried out on 18/05/2018

During a routine inspection

This practice is rated as Requires improvement overall. (Previous inspection 31 May 2016 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently 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

We carried out an announced comprehensive inspection at Dr N Driver and Partners on 18 May 2018. We inspected the provider 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.
  • However, there were no failsafe systems in place for patients cervical screening (smear) test results.
  • Medicines were safely and appropriately used and managed, with the exception of Patient Specific Directions (PSDs) for vitamin B12 injections. (PSDs are written instructions from a qualified and registered prescriber for a medicine or appliance to be supplied or administered to a named patient after the prescriber has assessed the patient on an individual basis.)
  • The practice routinely reviewed the effectiveness of the care it provided and 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 but reported that they were not able to access care easily when they needed it or appointments were delayed.
  • The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.
  • There was a focus on continuous learning and improvement at all levels of the organisation.

The areas of practice where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review and improve recording of patients chaperoning arrangements.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 31 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Driver and partners on 31 May 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.
  • 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.
  • 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.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice worked effectively with the patient participation group (PPG) to ensure patient views about the service were communicated and areas for improvement were identified and addressed.
  • 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Continue to review telephone access for patients following the installation of the new telephone system in order to ascertain if patient satisfaction in this regard has improved.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice