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Oldfield Surgery Requires improvement

Reports


Inspection carried out on 27 July to 11 August 2021

During a routine inspection

We carried out an announced inspection at Oldfield Surgery from 27 July to 11 August.

Overall, the practice is rated as Requires Improvement.

The ratings for each key question are as follows:

Safe - Requires Improvement

Effective – Requires Improvement

Caring - Good

Responsive - Good

Well-led – Requires Improvement.

Following our previous inspection on 19 May 2019, the practice was rated Requires Improvement overall and for the safe and well-led domains. The practice was rated as good in all other areas.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Oldfield Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on the breach of regulation 17: Good Governance, found in May 2019.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our findings

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 and for the provision of safe, effective and well-led services. We have rated the population groups as rated Requires Improvement for long-term conditions and people experiencing poor mental health and good for all other population groups.

We found that:

  • Some of the systems and processes continued to require further improvements to provide the leadership team with assurances and oversight of the practices quality of care. In areas such as medicines management, , recruitment, staff vaccinations and the management of long-term conditions and people experiencing poor mental health.
  • The provider, Heart of Bath, had an active clinical research unit, run day to day by a clinical research nurse and study coordinator. Supported by a core research team that included two GP Partners, who were currently involved in over 20 research studies, working closely with the National Institute of Health Research (NIHR), universities and commercial sponsors. Since March 2020 they had focused on supporting Urgent Public Health Research, such as the Principal Trial, Virus Watch and surveys to understand the psychological response to the Covid-19 pandemic.
  • Patient experience surveys, taken following the research were positive, commenting that their experiences consistently exceeded expectations.
  • The provider, Heart of Bath, was a standalone Primary Care Network, that had fully supported the COVID 19 vaccination program for over 28,000 patients.
  • The surgery had systems and processes to keep people safe and safeguarded from abuse.
  • Staff had the information they needed to deliver safe care and treatment.
  • The practice learned and made improvements when things went wrong.
  • Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people.
  • The practice organised and delivered services to meet patients’ needs.
  • Staff reported the culture had improved as staff had risen to the challenges of working during the pandemic.
  • Staff described the leadership as improved and supportive.

We found breaches of regulation. The provider must:

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

The provider should:

  • Record the supervision of clinical staff.
  • Put a system in place that provides a safety net for the management of abnormal cervical smears.
  • Work towards achieving the national target for cervical screening of 80%.
  • Continue to monitor and improve patient access.

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 1 May 2019

During a routine inspection

We carried out an announced comprehensive inspection at Oldfield Surgery on 1 and 2 May 2019 as part of our inspection programme.

At this inspection we found:

  • There were systems in place to manage risk so that safety incidents were less likely to happen, however these had not been fully embedded since the merger of the practices to ensure full oversight. For example, recording of regular fire alarm testing. When incidents did happen, the practice learned from them and improved their processes.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • There was evidence of quality improvement programmes being undertaken.
  • There was a proactive approach to understanding the needs of different groups of people and to ensure they received the care to best meet their needs. For example, the implementation of an urgent care centre.
  • The practice acknowledged and responded to patient feedback. For example, a recruitment programme was in place for additional clinical staff to meet demand for appointments.
  • Governance processes were not always consistent. For example, high risk medicines and exception reporting.
  • The practice demonstrated that there was a focus on continuous improvement which was developing services.

The area where the provider must make improvements are:

  • 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:

  • Take action to improve and sustain the uptake of cervical cancer screening and childhood immunisations.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 16 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oldfield Surgery on 16 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.
  • 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.
  • 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:

  • The provider should ensure the new protocol and logging system they had implemented to reduce the potential of prescription paper misuse is sustained.
  • The practice should develop and implement an overall practice policy and audit process for the medicines kept in GPs bags used on home visits.
  • The practice, even when they have been checked, should retain copies of proof of identity for new employees.
  • The practice should ensure documentary evidence is kept to show that an overall health and safety risk assessment process had been carried out on both practice locations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 9 December 2013

During a routine inspection

People who use the service were given appropriate information and support regarding their care or treatment. On arrival at the surgery we saw there was a variety of information on display in the waiting area. This included health promotion leaflets and information about the services available at the surgery which included a range of alternative therapies.

We spoke with five patients who attended the surgery on the day of our inspection. They told us they were happy with the service. Comments included �its brilliant here, absolutely fantastic� and �staff are very respectful and always explain things well�.

We found staff were knowledgeable and experienced at referring people into secondary care such as hospital consultants or specialist services. People we met said when they had been referred the transfer of care was made effectively to the right person or department. We were told by people and staff the practice used the NHS Choose and Book system to ensure people had choice about where and when they were referred for surgery.

We saw the practice had safeguarding policies in place for both children and vulnerable adults. These were up to date and included contact details and flow charts of how to contact the local authority to make a referral. There were identified lead clinician�s with a clear role to oversee both safeguarding adults or children within the practice.

GPs and nurses were subject to a satisfactory Disclosure and Barring Service (DBS) check. This is a check to see if the person's has a criminal record. We were shown the up to date schedule of all staff DBS checks which the practice kept.

We saw evidence the practice also checked and maintained proof of a person�s qualifications or registration with the appropriate professional body. For example, a copy of General medical Council (GMC) registration or Nursing and Midwifery (NMC) registration and qualifications.

All of the patients we spoke with told us they never had any reason to complain but told us they would speak to the practice manager if needed. They also told us they believed if they made a complaint it would be dealt with appropriately. This meant patients had confidence their complaints would be fully investigated and resolved, where possible, to their satisfaction.