Alexandra Surgery

Letter from the Chief Inspector of General Practice

This practice is rated as Requires improvement overall.

(Previous inspection 1 December 2015 the practice was rated as Good.)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

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. 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/focused inspection at Alexandra Surgery on 18 January 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was carried out in line with our next phase inspection programme.

At this inspection we found:

• The practice had some well-managed systems in place to keep people safe and reduce risk so that safety incidents were less like to happen. When incidents did happen, the practice learned from them and improved their processes.

• Not all safety systems were operating effectively; including health and safety and emergency risk management.

• Some staff had not received mandatory training in safeguarding children, the Mental Capacity Act and information governance.

• Patients’ needs were effectively assessed and care and treatment was in line with evidence- based guidance.

• Performance data, particularly for people with long-term conditions was lower than local and national averages.

• Due to some inaccuracies in the performance data, the medical record system used was not able to assist the practice in monitoring patients effectively enough.

• Although there was evidence of some measures to review the effectiveness of the care, there was limited evidence that the practice was auditing medicines and antimicrobial use.

• There were many examples where 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. The practice offered a flexible range of appointments and services.

• There was a strong culture of support, openness and transparency among staff and leaders.

• Governance processes and systems for business planning, risk management, performance and quality improvement were not always operating effectively.

• Systems for engaging with patients and acting on concerns were not well-established.

We saw areas of outstanding practice:

The practice provided timely care in response to specific patient needs.

• Practice nurses visited housebound patients who lived out of area if they required blood tests, but were unable to access phlebotomy services in their area.

• GPs took urgent blood samples from patients during consultations to reduce delays in patients getting care and treatment.

• GPs worked closely with mental health teams. There was evidence of joint assessments with a consultant psychiatrist to get urgent mental health support for patients.

• GPs provided structured, regular appointments with some patients with complex, severe mental health needs on a fortnightly basis.

There was evidence of the practice showing kindness, respect and compassion to vulnerable patients and families.

• We saw examples of the practice providing individualised care provided to support vulnerable patients who were anxious about attending hospital appointments.

• One of the GPs provided out of hours support to patients’ families for those patients with severe mental health needs.

• We received 41 comments cards; all but one were highly positive about the level of care experienced.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care with regards to: clinical governance, risk management, quality improvement, monitoring care and treatment for patients and patient engagement.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Ensure there is an effective system for monitoring prescriptions that have been issued but not collected.

• Review the criminal records checks procedure for the practice.

• Ensure business continuity and skill mix if the practice manager is absent for a significant period of time.

• Improve uptake for screening programmes.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice