Archived: Boneyhay Surgery

We previously carried out an announced comprehensive inspection at Boneyhay Surgery in March 2019 as part of our inspection programme. The practice was rated as good overall but requires improvement in safe. The practice was found in breach of Regulation 12 Safe Care and Treatment; specifically, the registered person had not done all that was reasonably practicable to mitigate risks to health and safety of service users receiving care and treatment. In particular:

Effective systems were not in place for the monitoring of all high risk medicines prescribed.

Following our review of the information available to us, including information provided by the practice, we carried out an announced focused inspection at Boneyhay Surgery on 3 December 2019. We focused our inspection on the following key questions: safe; effective and well led. Due to the assurance received from our review of information, we carried forward the ratings for the following key questions: caring and responsive.

• At this inspection we found that the provider had met the requirement notice in relation to the breach of regulation 12 and had an auditable system for ensuring all patients who required high risk medicines were appropriately monitored prior to these medicines being prescribed. The practice had also sought managerial support from a larger local practice and had commenced the process to merge the two practices in 2020.

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, with requires improvement for providing an effective service. We rated the population groups as good with the exception of People with long term conditions and Families, children and young people, which have been rated as requires improvement.

We have rated the service as requires improvement for providing an effective service because:

• people with long term conditions had not all received annual follow up care as required.
• Childhood immunisation rates were significantly below national targets.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

In addition to the breach of regulations, the provider should:

• Improve the sharing of information about quality monitoring for example the quality outcome framework (QOF) with all clinical staff.
• Encourage all staff to use electronic reporting of incidents.
• Continue to develop the electronic alerts system.
• Develop a clear audit process which identifies when second audit required.

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

This practice is rated as Good overall. (Previous rating April 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Boneyhay Surgery on 12 March 2019 as part of our inspection programme, to follow up on breaches of regulations.

At our last inspection in April 2018, we found that the provider was in breach of regulations 12 and 17. The regulations were not being met as the registered person had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment. In particular:

Regulation 12:

• Health and safety risk assessments were not completed as required.
• Risk assessments of the safety and security of the premises had not been completed.
• COSHH risk assessments had not been completed.
• Non-clinical staff who acted as chaperones had not received appropriate training to support them in the role.
• Effective systems were not in place for the appropriate monitoring of all high-risk medicines prescribed.

Regulation 17:

The registered person had systems or processes in place that operated ineffectively in that they failed to enable the registered person to assess, monitor and improve the quality and safety of the services being provided. In particular:

There was a lack of management oversight of governance arrangements related to:

• Recruitment processes
• Staff lead roles and responsibilities
• Staff training.

At this inspection we found:

• That the practice had made significant improvements in most areas. However, they remained in breach of regulation 12 as: effective systems were not in place for the appropriate monitoring of all high-risk medicines prescribed.

• 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.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure effective systems are in place for the appropriate monitoring of all high-risk medicines prescribed.

The areas where the provider should make improvements are:

Complete the policies they have under review.

Take action to improve staff files and records.

Improve the recall process for patients with long-term conditions.

Take action to ensure furniture in clinical rooms is suitable for the intended purpose.

Take action to include the ongoing complaints process in response letters.

Review the requirement for nurse appointments when the nurse has days off.

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