Archived: The Drive Surgery

Letter from the Chief Inspector of General Practice

This inspection was an announced focused inspection carried out on 22 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 21 July 2016. At that inspection we rated the Safe, Responsive and Well-Led domains as Requires Improvement and Effective and Caring as Good leading to an overall rating of Requires Improvement. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Whilst the Safe and Well-Led domains are now rated as Good the Responsive domain is still rated as Requires Improvement.

Overall the practice is now rated as Good.

Our key findings were as follows:

• The National Patient Survey scores published in January 2017 were still significantly lower than the national average in a number of areas and whilst some improvements had been made this was still an area for improvement.
• The practice had taken action to install fire smoke detectors and for all portable electrical equipment to be tested annually.
• The practice’s fire evacuation plan was on display in several prominent places, including the waiting area and staff were aware of their responsibilities.
• As part of its comprehensive refurbishment programme, new flooring had been laid in all clinical areas, which included coved skirting, thereby reducing the risk of cross infection.
• The practice had installed new wash hand basins in all clinical rooms which were without plugs and with a smooth surface splash–back.
• The premises, whilst still limited for space were more suitable for the purpose of providing primary care, particularly in the new nurse’s room.
• The waiting area had been redesigned, thereby offering patients easier access to the reception desk and other clinical rooms.
• The practice had carefully considered the management of patients with long term conditions and had introduced additional doctor and nursing support to improve the management of these patients. They had evaluated and reviewed patients who had been exception reported in all clinical domains and were particularly looking at reducing exception reporting for both their COPD and mental health patients. A significant improvement had been seen in the exception reporting of their atrial fibrillation patients.
• The practice’s uptake for cervical screening was currently at 68% and the target was 80%. They were encouraging more females to engage in this programme, but had historically encountered some ethical issues. Further improvement was anticipated as a result of more input from GPs and additional nursing time.
• Uptake rates for childhood immunisations were currently 89% to 96% for 1 year olds and 84% to 94% for 2 year olds and above. These figures compared favourably with CCG and national rates.

The number of carers had increased to 216, which was 4% of the practice list size. Staff remained focused on increasing this number further.

There were areas of practice where the provider needs to make improvements.

         The provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, specifically relating to the review of and acting upon patient feedback on accessing services.
• The provider should:
• Install a privacy curtain around the examination couch in one of the GPs rooms.
• Remove patient’s paper records from an unlocked cupboard in the nurse’s room and keep in a secure place. 
• Permanent locums were part of the clinical team, however clinical matters were not being formally discussed with them, thereby ensuring they were fully involved in influencing how high quality care could be delivered and recorded.
• Consider the practicalities and seek professional guidance of how to safely evacuate a disabled patient through the fire exit to the rear of the premises, as access to this was not straightforward.
• Ensure the locum GPs training needs and records were up-to-date.
• Extend the cleaning record and checklist to include all areas.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice