Archived: Ashwood Surgery Limited

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashwood Surgery limited on the 21January 2015. As part of this inspection we made a further two unannounced visits to Ashwood Surgery on 9 and 10 March 2015. We gathered information from a variety of sources, spoke with patients, interviewed staff at all levels and checked the right systems and processes were in place.

Concerns regarding this practice from different sources had been raised with us in relation to access to appointments, lack of continuity of care, poor support of locum GPs and that often there was not a GP available to patients. We were told that there was instances when the lead GP was only available in the practice for a short period each day.

Specifically, we rated the practice inadequate for the service being well led, safe, responsive and effective it was rated as requires improvement in caring. It was also inadequate for providing services for the six population groups we reviewed.

We gave the practice an overall rating of ‘inadequate’.

• The practice had previously been inspected in June 2014. During which, we found concerns in relation to care and welfare of patients, safeguarding patients, cleanliness and infection control, management of medicines, requirements relating to workers, supporting workers and the management of records. There were also ongoing financial disputes regarding the payment of bills which resulted in a disruption to service provision. Concerns were also raised around lack or staff support and failure to pay some staff pension contributions. We saw that the practice had made some progress to address these concerns. However, we still found concerns at this inspection relating to assessing and monitoring the quality of service, governance arrangements, ineffective management of risks and monitoring of performance.

• The practice had reviewed and updated the staff handbook and a number of policies and procedures.

• Patients were at risk of harm because systems and processes were not sufficiently robust to keep them safe. For example the practice did not record all significant events in sufficient detail and therefore were unable to learn from these events and prevent reoccurrence.

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. Some safety information was recorded but action and learning from these was not always evident.

• Patients were positive about their interactions with staff and said they were treated with respect and dignity.

• Patients said they found it difficult to make an appointment which included same day urgent appointments. Patients also complained that sometimes there was no GP in the practice. The routine appointment system was not working, and patients were often waiting a long time for non-urgent appointments with the GP of their choice.

• Patients were unhappy about the frequent turnover of staff which led to the lack of clinical continuity of care.

• Lessons learned from significant events were not shared with staff so improvements could be made.

• There was little evidence that national best practice guidelines were being followed.

• We saw instances where patients received care from staff who had not completed appropriate training to deliver it.

• Patients experienced difficulties in accessing urgent appointments.

• The routine appointment system was not working, and patients were often waiting a long time for non-urgent appointments with the GP of their choice.

• There was no evidence of completed audit cycles beyond one audit cycle.

• There was a lack of continuity of care due to the changes in clinical staff. The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider needs to make improvements are;

Importantly, the provider must:

• Ensure there is a system in place for clinicians to be kept up to date with national guidance and guidelines.

• Ensure the practice monitor and review significant events.

• Ensure the practice have systems in place to review the effectiveness of learning from incidents.

• Ensure there are systems for assessing and monitoring risks and the quality of the service provision.

• Ensure audits of practice are undertaken, including completed clinical audit cycles.

• Ensure there are formal governance arrangements to improve patient care. All staff need to be aware of the importance of governance to improve patient care.

• Ensure a sufficient number of clinical staff are employed to safeguard the health, safety and welfare of patients.

• Ensure that patient records contain a rationale for the treatment prescribed and document sufficient information which would enable another clinician to effectively take over care for a patient.

• Ensure appropriate support and training is in place for the practice nurse and health care assistant.

In addition the provider should :

• Ensure the practice website provides up to date information to support patients.

• Ensure there is information to signpost patients to support services or advise on what action to take in an emergency.

• Ensure all staff are familiar and aware of the business continuity plan.

• Ensure there are systems so a locum GPs can access clinical peer support in the surgery.

• Ensure processes are in place to prevent accidental turn off of the vaccination storage fridge which is not hard wired.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice