This practice is rated as Good overall. (Previous inspection December 2016 – Requires improvement)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires improvement
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Requires improvement
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Drs Masterton, Thomson, Bolade & Otuguor on 15 March 2018, because we had previously identified areas where the practice was failing to meet the legal requirements in delivering care.
This was the practice’s third inspection. We first inspected on 26 July 2016 when we found significant concerns relating to safe recruitment of staff, management of medicines, arrangements for emergencies, infection control, managing test results, learning from significant events, staffing levels and support for staff (including induction, training and appraisal) and overall governance, including maintenance of appropriate policies. We rated the practice as inadequate.
Before the report of the July 2016 was published, we carried out a focused inspection on 1 December 2016, because of the delay in producing a finalised report and the safety concerns identified. Despite not having had a copy of the report from the previous inspection, we found that the practice had made substantial improvements, fully addressing most concerns and with actions underway to address those that remained. There remained some issues with how medicines were managed, with infection control, training and appraisal. We therefore rated the practice as requires improvement.
More details of the findings of the previous inspections are given under the key questions, below. You can read the report from the previous inspections by selecting the ‘all reports’ link for Drs Masterton, Thomson, Bolade & Otuguor on our website at www.cqc.org.uk.
At this inspection we found:
- In general, the practice had maintained the improvements made previously. Although there were issues in some of the same areas, these were not the same as previously identified (so the issues did not reflect a failure to act by the practice).
- There were systems to assess, monitor and manage risks to patient safety, although there were aspects that needed to be strengthened, particularly related to documentation of recruitment checks.
- There was an effective system for staff training and appraisal, but the practice policy did not include all of the training recommended by national guidance.
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes, although formal documentation sometimes followed later.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- Measures of the effectiveness of care showed the practice was performing in line with local and national averages (although not always up to the national target). Exception rates (patients excluded from performance data) for chronic obstructive pulmonary disease were above average, but this appeared to be linked to the practice’s older population.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients told us that they found the appointment system easy to use and reported that they were usually able to access care when they needed it, although some patients reported that it could be difficult to get appointments with particular GPs and sometimes with a female GP. Patients reported that they sometimes had to wait too long after their appointment time.
- There was continuous learning and improvement at all levels of the organisation. This had after the first inspection focused on patient safety, but was extending to other aspects of the practice’s care and services.
The areas where the provider must make improvements:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please go to the requirement notice section at the end of the report for more detail.)
The areas where the provider should make improvements are:
- Review the causes of long waiting times and the below 80% cervical screening rate and consider actions.
- Consider if there are ways to improve accessibility to consulting rooms for patients with impaired mobility, and ways to support patients’ understanding, for example by using easy read materials.
- Review staff training in consent, including the mental capacity act.
- Continue to monitor high exception rates for chronic obstructive pulmonary disease to ensure exceptions remain clinically appropriate.
- Review whether there is sufficient access to female GP appointments and nurse appointments.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice