Archived: Kingswell Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 18 April 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing.

We undertook this focused inspection on 3 October 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports'link for Dr John Davies on our website at www.cqc.org.uk.

During this inspection, we found the practice had made some improvements since our last inspection and they were meeting one of the three regulations which had previously been breached. However the provider is in breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe care and treatment and Regulation 17 Good Governance.

The ratings for the practice have been updated to reflect our findings. We found the practice and to require improvement in areas relating to safe and well-led. 

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

• The practice had reviewed its processes and practices in place to keep patients safe and safeguarded from abuse. All clinical staff had now completed child and adult safeguarding training.
• Staff had placed a notice in the waiting room to inform patients’ chaperones were available if required.
• We observed cleats had been installed to blinds in the practice to meet Department of Health guidance from February 2015 to reduce the risk of serious injury to children and adults due to entanglement.
• The practice had reviewed the actions taken in relation to fire safety and all staff had undertaken annual basic life support training in July 2016.
• The practice had purchased a defibrillator which was available on the premises along with oxygen.
• The practice had reviewed the process for reporting and recording near misses and significant events in the dispensary, which included introducing a near miss log. However, we noted staff did not consistently follow the procedure.
• Standard Operating Procedures (SOPs) were in place for most aspects of medicines management (these are written instructions about how to safely dispense medicines). However, some were overdue a review and others had not been signed by relevant staff.
• The practice did not comply with The Misuse of Drugs Regulations 2001 (and subsequent amendments). Controlled drugs were stored securely, however, records did not accurately reflect the stock held in the controlled drugs cupboard on the day of our inspection.

The areas where the provider must make improvements are: 

• Ensure the controlled drugs register meets the requirements set out in The Misuse of Drugs Regulations 2001 (and subsequent amendments) and regular checks of stock completed and documented.
• Ensure regular stock checks of dispensary items are performed and records kept.
• Ensure acute prescriptions are signed, as per practice policy, by the end of the day they are collected by the patient.
• Ensure the process for reporting and recording near misses and significant events in the dispensary is aligned to the practice significant event policy and learning is shared with staff.
• Ensure the review of dispensary Standard Operating Procedures (SOPs) is timely, review dates are documented and updates are shared with staff.

​In addition the provider should: ​

• Review and introduce a procedure to review staff competency to work in the dispensary.
• Keep a record of prescription numbers received in to the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr John Davies’ practice on 18 April 2016. Overall the practice is rated as requires improvement.

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

• Patients told us that they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.

• Staff did not always understand and fulfil their responsibilities to raise concerns, and to report incidents and near misses. The practice did not keep a near miss record of dispensing errors that have been identified before medicines have left the dispensary. Staff could not tell us how dispensing errors were recorded or reported.
• The practice was not able to demonstrate they were equipped for dealing with emergencies due to a failure to risk assess the provision of emergency equipment and medicines.
• Recognised guidance had not been followed to ensure safe storage of medicines requiring refrigeration, fridge temperatures had not always been recorded correctly and action taken when fridge temperatures were outside of the recommended ranges was not recorded.

• The learning needs of staff were not always identified through a system of appraisals, meetings and reviews of practice development needs.

• There was no evidence of formal team or clinical meetings since January 2015.

• Patients told us they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The practice had a number of policies and procedures to govern activity.
• The practice had proactively sought feedback from patients which it acted upon.
• There was a clear leadership structure and staff felt supported by management.
• The registered provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure that arrangements are in place for the safe management of medicines.
• Review the provision of equipment and medicines for use in an emergency.

• Ensure all staff are supported to participate in statutory training.

• Ensure all staff receive regular appraisal of their performance in their role from an appropriately skilled and experienced person and consider need to include clinical appraisal for staff who may require this.

In addition the provider should:

• Introduce a system to ensure standard operating procedures are regularly reviewed and followed by dispensary staff.

• Develop a process for embedding and reviewing the effectiveness of the recently introduced process for monitoring blank prescriptions within the practice.

• Continue recently introduced fire drills regularly to monitor and ensure staff are aware of the procedures to take in the event of a fire.

• Review the recruitment process to ensure that all of the required pre employment checks are carried out for all staff before they commence employment at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice