Background to this inspection
Updated
13 August 2021
The Friendly Family Surgery is a single-handed GP practice and is located in Bolsover in North East Derbyshire at:
Welbeck Road
Bolsover
Chesterfield
Derbyshire
S44 6DE
We visited The Friendly Family Surgery as part of this inspection.
The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, family planning and treatment of disease, disorder or injury.
The practice is situated within the NHS Derby and Derbyshire Clinical Commissioning Group (CCG) and delivers Personal Medical Services (PMS) to a patient population of approximately 3,407 patients. This is part of a contract held with NHS England. The practice is part of North Hardwick and Bolsover Primary Care Network, a wider network of seven GP practices that work collaboratively to deliver primary care services.
Information published by Public Health England shows that deprivation within the practice population group is in the fourth lowest decile (four of 10). The lower the decile, the more deprived the practice population is relative to others. The age profile demonstrates a higher proportion of older patients, and lower numbers of younger patients compared to local and national averages:
- The percentage of older people registered with the practice is 27.6% which is above the Clinical Commissioning Group (CCG) average of 20.2%, and the national average of 17.6%.
- The percentage of young people registered with the practice is 15% which is below the CCG average of 19.5%, and the national average of 20.2%.
The National General Practice Profile describes the practice ethnicity as being predominantly white at 98.4% of the registered patients, with estimates of 0.5% mixed race, 0.6% Asian, 0.4% black and 0.1% other groups.
There is a team of two GPs working at the practice (one female GP and one salaried male GP), an advanced nurse practitioner, a health care assistant and two care co-ordinators. The non-clinical team is led by a practice manager with a team of 10 administrative and secretarial staff.
Due to the enhanced infection prevention and control measures put in place since the Covid-19 pandemic and in line with the national guidance, most GP appointments were telephone consultations. If the GP needs to see a patient face-to-face then the patient is offered an appointment at the practice.
Extended access is provided locally by North Hardwick and Bolsover Primary Care Network where late evening and weekend appointments are available. Out of hours services are provided by Derbyshire Health United (DHU).
Updated
13 August 2021
We carried out an announced, focused inspection at The Friendly Family Surgery on 2 August 2021. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions: safe, effective and well-led. Due to assurances we received from our review of information, we carried forward the ratings of good from our previous inspection in January 2020 for the following key questions: caring and responsive. The practice is rated as Good overall and in all key questions.
Following our previous inspection on 27 January 2020, the practice was rated Requires Improvement overall. It was rated requires improvement in the key questions safe, effective and well-led and good in caring and responsive.
The full report for the previous inspection can be found by selecting the ‘all reports’ link for The Friendly Family Surgery on our website at www.cqc.org.uk
Why we carried out this inspection.
This inspection was a focused inspection to follow up on:
- Breaches in regulations relating to safe care and treatment and good governance.
- Two best practice recommendations:
- Continue to implement the changes made to the in-house approach to the management of long-term conditions and improve patient outcomes in line with local and national averages.
- Improve engagement with national cancer screening and childhood immunisation programmes.
How we carried out the inspection
Throughout the Covid-19 pandemic the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included:
- Conducting staff interviews using video conferencing
- Completing clinical searches on the practice’s patient records system and discussing findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider
- A short site visit
Our findings
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
- information from the provider, patients, the public and other organisations.
We have rated this practice as Good overall and 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.
- The practice maintained safeguarding lists of children at risk and vulnerable adults. They also maintained a ‘watch’ list for patients with the potential to develop safeguarding concerns who may require additional support.
- There were protocols and searches in place for the monitoring of patients prescribed high risk medicines and diagnosis of long-term conditions. However, we identified a small number of patients who had not received the required monitoring or potentially had a misdiagnosis. The provider sent an action plan to the CQC immediately after our inspection demonstrating the actions they had taken to address these findings.
- Systems for tracking prescription stationery throughout the practice were updated during our inspection.
- There was a system in place for reporting and acting on significant events however, the reporting forms lacked detail.
- Patients received effective care and treatment that met their needs.
- The practice had achieved 100% for all five childhood immunisation uptake indicators and exceeded the WHO based national target of 95%.
- The practice had adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
- The way the practice was led and managed promoted the delivery of high-quality, person-centre care and supported staff.
- Staff told us that they could not have asked for more support than that provided by the provider throughout the Covid-19 pandemic and that there was an open and honest culture within the practice.
Whilst we found no breaches of regulations, the provider should:
- Continue to act on their action plan for monitoring patients prescribed high risk medicines. Particularly medicines used for the treatment of heart failure, mood stabilisation and prevention of stroke. Continue to act on their plan to mitigate risks of misdiagnosis of long-term conditions such as diabetes or chronic kidney disease.
- Continue to embed into practice the protocol changes made to track prescription stationery throughout the practice.
- Update safeguarding policies to include all the categories of abuse. For example, human trafficking or modern slavery.
- Enhance the level of detail in the significant event analysis forms to support staff to understand and learn from the events.
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