Archived: Dr Louise Miller

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Louise Miller on 20 April 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and appropriate checks had not been put in place to reduce the risks associated with infection control and general health and safety.

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

• There was no robust system in place to ensure staff had completed training appropriate to their role.

• The practice had a number of policies and procedures to govern activity, but some were overdue a review and not practice specific.

• The practice’s Patient Participation group (PPG) had not met since February 2014. It was not clear what their role was and how it was supporting practice improvements.

• There was a leadership structure and staff felt supported by management. However, there was limited formal governance arrangements.

• Data showed patient outcomes were comparable to national averages.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect.

• Although, urgent appointments were usually available on the day they were requested; only 48% of patients stated in the most recent patient’s survey that they were able to get an appointment to see or speak to someone the last time they tried (compared to the national average of 76%).

The areas where the provider must make improvements are:

• Ensure recruitment and on going monitoring arrangements include all necessary employment checks for all staff.

• Ensure all chaperones have undertaken a DBS check or the lack of a DBS check is risk assessed.

• Ensure emergency equipment is regularly checked, fit for use for both adults and children; and is stored appropriately and easily accessible should there be an emergency situation.

• Implement a robust process and system for managing and acting on infection prevention and control risks.

• Ensure that staff receive appropriate support, training and appraisal as is necessary to enable them to carry out the duties they are employed to perform. For example, Ensure staff are appropriately trained in protecting vulnerable children and adults.

• Implement a robust complaints system and procedure in line with NHS guidelines.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provided. For example, introduce a system for reporting, recording, acting on and monitoring significant events, incidents and near misses. Develop a programme of quality improvement, to improve patient outcomes and updated policies and procedures that are reflective of the requirements of the practice and in line with essential and national guidelines.

In addition the provider should:

• Develop an active patient participation group and process that helps to drive forward positive changes for the benefit of the patient community.

• Put in place a process to monitor the use of prescription pads..

• Review the provision of non-urgent appointments to improve access to the practice.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice