Archived: Manor Oak Surgery

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Manor Oak Surgery in Horam, East Sussex on 10 January 2017 we found a breach of regulation relating to the provision of effective services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of effective services and good for the provision of safe, caring, responsive and well-led services. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Manor Oak Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 27 June 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 in January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Our key findings were as follows:

• The practice had implemented a system for completing a wide range of clinical audits including a clinical audit schedule with the view to increase the level of clinical audit activity, ensuring quality improvement. We saw all clinicians (GPs and nurses) were now actively involved in completing clinical audits. Furthermore, we saw audits had been completed which reviewed clinical intervention against national and local guidelines and established best practice.

• Patient satisfaction was closely monitored through a series of patient surveys. The practice proactively sought patients’ feedback and engaged patients in the delivery of the service. For example, with a view to improve patient satisfaction levels in relation to opening hours there was a patient consultation to review the current opening times and existing extended opening hours. This consultation aimed to ensure the practice, the opening times and extended opening hours met patient needs.

• Further steps had been taken to reinstate their website. Although not yet live, we saw the prototype website contained information about the practice and various articles from the patient participation group (PPG). Until the website was live (no date confirmed), the practice ensured the practices profile on NHS Choices website was up to date.

• Arrangements for handling complaints and concerns had been strengthened. The complaints procedure was now in line with recognised guidance and contractual obligations for GPs in England. This now included information about how to escalate concerns if the complainant was not satisfied with the response from the practice.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). Various actions had been taken to improve areas of low performance. We saw these actions had been successful as the most recent results indicated performance for the vast majority of diabetes related indicators had improved when compared with the previous year’s performance. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 87%. This was a 16% improvement on the previous year’s performance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Oak Surgery on 10 January 2017. Overall the practice is rated as Good.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• 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.
• 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 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 provider did not regularly carry out full cycle clinical audits to ensure they were meeting national and local clinical guidelines and providing quality outcomes for patients.

The areas where the provider must make improvements are:

• The provider must ensure a regular programme of quality improvement such as clinical audit takes place to review clinical intervention against national and local guidelines and established best practice.

The areas where the provider should make improvements are:

• The provider should continue to monitor patient satisfaction levels in relation to recommendation and opening hours to ensure they meet patient needs.
• The provider should take steps to reinstate their website.
• The provider should ensure responses to complaints contain signposting to the next steps the complainant can take if they are not happy with the practice’s response.
• The practice should keep their diabetes performance under review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice