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A review of one or more of the ratings contained within the inspection report has been carried out at the request of the provider. Further to the review the ratings within this report have changed.

Inspection Summary


Overall summary & rating

Good

Updated 8 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at First Care Practice on 11 October 2016. The overall rating for the practice was requires improvement. We also rated the practice as requires improvement for providing caring and responsive services and issued a requirement notice in relation to a breach of regulation 17. This was because the practice could not demonstrate it had sufficient staff capacity to meet the needs of patients and provide an accessible service.

We also noted that the practice:

  • scored consistently below the local and national averages on the 2016 national GP patient survey
  • had identified fewer than 1% of its patients as carers.

The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for First Care Practice on our website at www.cqc.org.uk.

This inspection was a focused inspection carried out on 11 December 2017 to confirm that the practice had made improvements since our last inspection and was now meeting legal requirements.

We also followed up concerns received by the Care Quality Commission about the quality of care and leadership at the practice.

Following this inspection, we have rated the practice as good overall. We have rated the practice as good for providing caring and responsive services. We did not find evidence to substantiate the concerns which had been reported to us and the practice's ratings for providing safe, effective and well-led care remain as good.

Our key findings were as follows:

  • Since our previous inspection, the practice had increased its clinical capacity and the number of GP and nursing sessions it provided each week. 
  • The practice now used regular salaried or locum clinicians to facilitate continuity of care for patients with complex or longer term conditions. 
  • The practice promoted telephone consultations where appropriate and online appointment booking to better manage demand.
  • The practice's results on the national GP patient survey remained below average in 2017. However, the practice had noted the response rate to this survey was low and had carried out its own survey of patients which showed improving satisfaction levels.
  • The practice had increased the number of patients it had identified as carers to 91. The practice offered carers additional support and flexibility in making appointments.
  • The practice provided a responsive service. It had a young population and had identified health promotion and lifestyle advice as a key priority for this population group.
  • The practice was looking at innovative ways to support and engage patients to manage their own health where appropriate.
  • The practice provided an accessible service. The practice was open seven days a week and over public holidays. Emergency and same day appointments were available for patients who required more urgent access.

The areas where the practice should make improvement are:

  • The practice should review and, if appropriate, work to reduce its exception reporting rates for cervical screening which were relatively high in 2016/17.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 July 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

  • Some arrangements were in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs, however, patient feedback was that there was lack of continuity of care for patients as there was only one permanent GP working at the practice.

Effective

Good

Updated 18 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the local and national average for diabetes and mental health.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 8 February 2018

Responsive

Good

Updated 8 February 2018

Well-led

Good

Updated 18 July 2017

The practice is rated as good for being well-led.

  • The practice had a vision and strategy to deliver quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework that supported the delivery of the strategy and good quality care. However, there was lack of continuity of care for patients. Some arrangements were in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs, however, as there was only one permanent GP working at the practice, other appointments were covered by various locum GPs.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 8 February 2018

Families, children and young people

Good

Updated 8 February 2018

Older people

Good

Updated 8 February 2018

Working age people (including those recently retired and students)

Good

Updated 8 February 2018

People experiencing poor mental health (including people with dementia)

Good

Updated 8 February 2018

People whose circumstances may make them vulnerable

Good

Updated 8 February 2018