Dr Christopher Cole and Partners Also known as The Red and Green Practice

We previously carried out an announced focused inspection at Dr Christopher Cole and Partners, on 28 January 2020 as part of our inspection programme to follow up on concerns and breaches of regulations following our previous inspection in December 2018. We rated the practice as Good overall, however we found a breach of regulations and rated the key area of Safe provision of services as Requires Improvement. You can read the full report by selecting the ‘all reports’ link for Dr Christopher Cole and Partners on our website at .

We were mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate, this was therefore a desk-based review. On 26 August 2020, we commenced the desk-based review to confirm that the practice had carried out its plan to meet the legal requirements in relation to the breach of regulations that we identified at our previous inspection in January 2020.

We found that the practice is now meeting those requirements and we have amended the rating for this practice accordingly. The practice is now rated Good for the provision of Safe services. We previously rated the practice as Good for providing Effective, Caring, Responsive and Well-Led services.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we reviewed the information sent to us by the provider
• information from our ongoing monitoring of data about services and
• information from the provider.

We have rated Safe as Good because:

• The practice had identified and completed actions, in response areas identified as requiring improvement at our previous inspection in January 2020.
• The practice demonstrated it had revised its Disclosure & Barring Service (DBS) procedures. We reviewed an associated risk assessment that the practice had completed for a staff member who had started employment prior to their DBS being confirmed.
• The practice demonstrated it had revised recruitment processes, and had identified a dedicated staff member responsible for the checking identification documents, to ensure incoming staff member details were correct.
• The practice demonstrated it had improved its security and monitoring processes of blank prescription stationery. This included comprehensive documentation of blank prescription scripts in line with national guidance, and the removal of all but two centralised printers within the practice’s sites, where blank prescription stationery was used.
• The practice provided data to show it had increased the usage of the Electronic Prescription Service (EPS) since July 2018 from 87% to 97% by July 2020, which indicated less reliance on paper prescriptions being issued at the practice.

Although not part of the practice’s previous regulatory breach, the practice demonstrated it had also made improvements since our last inspection which included:

• Producing a comprehensive risk assessment for its staff regarding their vaccination status.
• Completing a hand-hygiene audit with a random selection of staff to ensure appropriate hand-hygiene measures were in place and staff were compliant with the requirements expected by the practice.
• Identifying learning from an incident involving unpacked vaccines found at our previous inspection. The practice provided copies of delivery audit forms and vaccine stock checks to demonstrate that no further such incidences had occurred.

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

We carried out an announced comprehensive inspection at Dr Christopher Cole and Partners on 28 January 2020 as part of our inspection programme to follow up on concerns and breaches of regulations following our previous inspections in December 2018 and November 2017.

At the last inspection, on 20 December 2018, we rated the practice as Requires Improvement overall. Specifically, we rated the practice as Requires Improvement for providing safe and well-led services. We issued a Requirement Notice for Regulation 17: Good Governance.

At this inspection, on 28 January 2020 we found that the provider had adequately addressed our previous concerns but new concerns were identified.

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 Good overall but we have continued to rate the practice as Requires Improvement for providing safe services. We have rated this practice as good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. However, that did not include the mitigation of risk relating to the completion of Disclosure and Barring Service checks, staff name changes, nor prescription stationery security when in use.
• The practice had improved its processes around the clinical supervision and monitoring of prescribing practices of its staff employed in advanced clinical roles.
• Patients received effective care and treatment that met their needs.
• The practice had revised its annual recall and exception reporting systems to the extent that an increase in patient uptake and a lowering of exception reporting figures had been demonstrated.
• The practice had a dedicated training officer to support staff in accessing and completing the expected training requirements set by the practice.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had increased its number of patients who also identified as carers and offered appropriate support according to their needs.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice had supported and facilitated new incentives to support its patients. For example, the creation of a garden in the practice grounds, which patients could visit, as well as get involved with, to support their physical and mental well-being, and a bereavement support group.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• Governance arrangements had not ensured appropriate oversight was in place in relation to adequate vaccine stock control, monitoring of blank prescription stationery, appropriate staff recruitment checks, and the completion of Disclosure and Barring Service checks.

The areas 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:

• Continue to improve patient satisfaction in relation to continuity of care.
• Continue to lower exception reporting rates.
• Seek assurances that staff are following correct procedures relating to infection control and prevention, for example, hand hygiene.
• Revise how stock control measures are carried out to mitigate the risk of vaccines not being unpacked in a timely manner.

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