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Inspection carried out on 8 November 2016

During a routine inspection

Letter from the Chief Inspector of General

Practice

We carried out an announced comprehensive inspection at Saxonbrook Medical on 15 March 2016. The practice was rated as requires improvement for safe, effective, responsive and well-led services and overall. They were rated as good in caring. On 8 November 2016 we undertook a further comprehensive inspection. 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 a system in place for reporting and recording significant events. Improvements had been made to the reporting and recording of significant events and there was evidence of discussion and learning with staff.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety. Improvements had been made with the development of a range of risk assessments and the way in which risks were managed was evident. Health and safety, legionella, electrical testing and equipment calibration had been addressed through this process.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect although results for patients feeling involved in their care and decisions about their treatment were lower than the national average.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. The process for managing complaints had improved with evidence of patient apologies and the identification of trends.
  • Patients and staff we spoke with said improvements had been made in accessing appointments with the newly developed call and triage system. National survey results demonstration that satisfaction was below average in this area, however on the day of inspection patients told us there had been recent significant improvements with this.
  • 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. Staff told us that communication had improved and they felt involved in the development of the practice.
  • The provider was aware of the requirements of the duty of candour.
  • Clinical audits were undertaken and we saw evidence that some of these were full cycle. The practice had made improvements in this area and had held audit meetings with the multi-disciplinary team to develop a programme and involve a range of clinical staff.
  • Patient outcomes were mixed, with some areas of performance below average, such as in relation to asthma and chronic obstructive pulmonary disease. Exception reporting was higher than average in some areas. However, these issues were adversely affected by changes within the practice including relocation, an influx of patients registering with the practice from a local walk in centre and a high proportion of patients from hard to reach groups. The practice were working to make improvements and there were demonstrable improvements in diabetes performance since the previous inspection. Unpublished data showed an increase of sixteen percentage points in the number of patients receiving a foot examination.

  • Mental health performance was below average; however the practice had developed a dedicated mental health and wellbeing service which had recently won national awards.
  • The practice had made improvements in mandatory training attendance for staff with the development of a range of training available including online and some in-house sessions to ensure that training was timely. However, records relating to induction were not always evident or complete.

We saw one area of outstanding practice:

  • A mental health wellbeing service had been developed within the practice. This provided patients with support with a number of issues including anxiety, depression, eating and mood disorders. The service also provided support around the long term management of chronic conditions such as schizophrenia. Data showed that the service had reduced the number of referrals into secondary care mental health services. The service had been the recent recipient of the Nursing Times ‘Nursing in Mental Health’ category and the clinical lead for the practice had been awarded the Nurse of the Year for the development of the service.

The areas where the provide should make improvements are:

  • Ensure that induction records are complete for new staff.

  • Ensure that improvements are made to the way in which the practice identifies carers.

  • Ensure that all aspects of underperformance in the national GP patient survey are addressed, including areas such as patients not feeling involved in the planning of their care.

  • Continue to work to improve patient outcomes (QOF) within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 15 March 2016

During a routine inspection

Letter from the Chief Inspector of General

Practice

We carried out an announced comprehensive inspection at Saxonbrook Medical on 15 March 2016. The practice was rated as requires improvement for safe, effective, responsive and well-led services and overall. They were rated as good in caring. On 8 November 2016 we undertook a further comprehensive inspection. 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 a system in place for reporting and recording significant events. Improvements had been made to the reporting and recording of significant events and there was evidence of discussion and learning with staff.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety. Improvements had been made with the development of a range of risk assessments and the way in which risks were managed was evident. Health and safety, legionella, electrical testing and equipment calibration had been addressed through this process.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect although results for patients feeling involved in their care and decisions about their treatment were lower than the national average.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. The process for managing complaints had improved with evidence of patient apologies and the identification of trends.
  • Patients and staff we spoke with said improvements had been made in accessing appointments with the newly developed call and triage system. National survey results demonstration that satisfaction was below average in this area, however on the day of inspection patients told us there had been recent significant improvements with this.
  • 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. Staff told us that communication had improved and they felt involved in the development of the practice.
  • The provider was aware of the requirements of the duty of candour.
  • Clinical audits were undertaken and we saw evidence that some of these were full cycle. The practice had made improvements in this area and had held audit meetings with the multi-disciplinary team to develop a programme and involve a range of clinical staff.
  • Patient outcomes were mixed, with some areas of performance below average, such as in relation to asthma and chronic obstructive pulmonary disease. Exception reporting was higher than average in some areas. However, these issues were adversely affected by changes within the practice including relocation, an influx of patients registering with the practice from a local walk in centre and a high proportion of patients from hard to reach groups. The practice were working to make improvements and there were demonstrable improvements in diabetes performance since the previous inspection. Unpublished data showed an increase of sixteen percentage points in the number of patients receiving a foot examination.

  • Mental health performance was below average; however the practice had developed a dedicated mental health and wellbeing service which had recently won national awards.
  • The practice had made improvements in mandatory training attendance for staff with the development of a range of training available including online and some in-house sessions to ensure that training was timely. However, records relating to induction were not always evident or complete.

We saw one area of outstanding practice:

  • A mental health wellbeing service had been developed within the practice. This provided patients with support with a number of issues including anxiety, depression, eating and mood disorders. The service also provided support around the long term management of chronic conditions such as schizophrenia. Data showed that the service had reduced the number of referrals into secondary care mental health services. The service had been the recent recipient of the Nursing Times ‘Nursing in Mental Health’ category and the clinical lead for the practice had been awarded the Nurse of the Year for the development of the service.

The areas where the provide should make improvements are:

  • Ensure that induction records are complete for new staff.

  • Ensure that improvements are made to the way in which the practice identifies carers.

  • Ensure that all aspects of underperformance in the national GP patient survey are addressed, including areas such as patients not feeling involved in the planning of their care.

  • Continue to work to improve patient outcomes (QOF) within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.