Archived: The Coach House Surgery

We carried out an announced comprehensive inspection at The Coach House Surgery on 17 January 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety but incidents that ought to have been reported had not been reported. There was no system for monitoring the actions necessary to mitigate the risks identified from safety alerts.
• Most staff assessed patients’ needs and delivered care in line with current evidence based guidance. However we found that not all GPs were able to demonstrate familiarity with NICE guidance and was unaware of some local guidance. Staff had the experience, and had been trained to provide them with the skills and knowledge, 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. However some decisions and diagnoses entered in patients’ records were not coded so the records were incomplete.
• 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.
• There was no programme of clinical audit or plan for continuous improvement.
• There was a clear leadership structure and some staff felt supported by management but the management team was divided and clinical governance was ineffective. The practice 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.

There were areas of practice where the provider must make improvements:

• Ensure that patients’ assessments are carried out in accordance with current evidence based guidance and standards.
• Ensure that there is an effective scheme of governance to assess, monitor and improve the quality and safety of the services provided
• All GPs should be trained to child protection or child safeguarding level three.

We saw one area of outstanding practice:

• There was an over age 75’s health check and frailty assessment offered in the patient’s home. These checks were carried out by health care assistants. The practice said that this helped with the early identification of patients who were becoming confused, frail or socially isolated.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice