Archived: The Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery on 7 December 2016. Overall the practice is rated as Requires Improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The systems and processes to assess and address risks to patients were not implemented well enough to ensure patients were kept safe. For example, in areas such as infection prevention and control, fire safety, storage of vaccines and recruitment.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with dignity and respect but they sometimes felt they were not listened to or involved in decisions about their care.
• Information about services and how to complain was available and easy to understand although the procedure required updating. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs although cleaning of the premises required improvement.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The practice had recognised the challenges relating to their practice and the management team were aware they had areas for improvement. They had recently implemented The NHS Institute for Innovation and Improvement’s Productive General Practice programme to assist them to improve.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Improve systems for the management of safety alerts to ensure all alerts are actioned in a timely manner commensurate with risk and a record of actions taken is maintained. Review and implement the actions in the Department of Health estates and facilities alert January 2015 relating to blinds and blind cords to minimise the risk of serious injury due to entanglement.

• Review the infection prevention and control risk assessment and improve infection prevention and control (IPC) processes and monitoring systems in line with The Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance. Maintain the practice in a clean condition.

• Implement systems for the management and storage of blank prescription forms in line with NHS Protect; security of prescription forms guidance, 2013.

• Implement systems to ensure the cold chain is maintained in the vaccine storage fridge. Ensure appropriate action is taken and a record of the action taken is maintained when temperatures are outside the recommended ranges in line with Public Health England; Protocol for ordering, storing and handling vaccines 2014. Take action to mitigate risks related to vaccines which have been stored outside the recommended ranges and report to the relevant organisations.

• Consistently implement the practice recruitment policy and procedure and ensure all appropriate recruitment checks are completed prior to employment.

• Complete a fire risk assessment and put processes in place to ensure the fire equipment, such as the fire alarm, is in working order. Ensure the fire door at the bottom of the stairs can be closed, signage for all final exit doors is provided and the storage arrangements for oxygen are risk assessed. Provide a warning sign in all areas where liquid nitrogen is stored.

The areas where the provider should make improvement are:

• Review the chaperone policy and procedure and put procedures in place to ensure this is implemented consistently.

• Review the Legionella risk assessment to assess if all mitigating actions have been implemented to minimise on-going risk.

• Emergency equipment should be checked at least weekly in line with recommendations by the Resuscitation Council. (UK) guidelines.

• Put processes in place to ensure all staff have an annual appraisal.

• Maintain records of staff induction training.

• Review and improve patient satisfaction in relation to GP consultations.

• Update the complaints procedure with the Parliamentary Health Services Ombudsman contact details for escalation of complaints.

• Review the storage security arrangements for patient records.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice