Archived: Dr Mark Webster Also known as Frenchwood Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mark Webster also known as Frenchwood Surgery, on 19 September 2016. This was to check that the practice had taken sufficient action to address a number of significant concerns we had identified during our previous inspection in January 2016. Following the inspection in January 2016 the practice was rated as inadequate for providing safe, effective and well-led services, and as requires improvement for providing responsive and caring services. Overall the practice was rated as inadequate.

We issued three warning notices and two requirement notices under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and placed the practice in special measures as a result.

At this inspection we found the practice had made significant improvements in regards to the safety of the practice and had taken the action required to meet the warning notices. However we found that there were still areas that required improvement.

Overall the practice is now rated as: Requires improvement

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

• Patient outcomes were hard to identify as some clinical audits were basic and clinical quality improvement work was in effect data collection only.
• Although there had been improvement, some medication reviews were still overdue and work to reduce this had not been implemented in a timely manner
• Prescribing for the practice was inconsistent with local and national trends and there was little evidence of any strategy to improve this.
• Leadership within the practice was limited.

However:

• There was an improved, open and transparent approach to safety which had been implemented, particularly for reporting and recording significant events. This included new policy guidance for staff.
• Risks to patients were more effectively assessed and better managed. A risk management and health and safety file had been implemented.
• Recruitment processes were more comprehensive and staff personal files were better organised, with the required and more detailed, recruitment information in place.
• A practice nurse had been employed with the skills, knowledge and experience to deliver effective care and treatment.
• Patients we spoke with said they were treated with compassion, dignity and respect and felt they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand...
• Patients said they found it very easy to make an appointment with the GP and practice nurse, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The 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 quality improvement activity, including clinical audits are more comprehensive and undertaken to initiate improvements in patient care and treatment.

• Ensure a more effective system in place in order that patients received appropriate and timely medication reviews.

• Ensure there is a comprehensive review of prescribing trends within the practice to reflect best practice and local and national trends.
• Implement policy guidance staff in relation to consent procedures

The areas where the provider should make improvement are:

• Continue to sustain the improvements made to the overall governance of the practice.

• Continue to have oversight and support of the practice nurse in order that clinical reviews continue to be completed in a more timely manner

• Continue to review the number of patients who are also carers in order to provide appropriate support

The practice has made improvements and I am taking this service out of special measures. The service will be kept under review and if needed could be escalated to urgent enforcement action. A further inspection will be conducted within six months.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General 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 on 27 January 2016. Overall the practice is rated as Inadequate. Specifically, we found the practice to be inadequate for providing safe, effective  and well-led services and requires improvement for providing  responsive and caring services.

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

• There was no system in place to effectively manage and mitigate risks to patients and staff. There were no policies or risk assessments in place in regards to the environment or how to manage medical emergencies.

• Significant events or incidents were not effectively recorded to demonstrate appropriate and timely action had been undertaken. Staff did not have written guidance on how to manage significant events.

• The practice manager attended some external multi-disciplinary meetings. However the minutes of these meetings did not record any detail of the discussions held. The practice did not hold regular practice or governance meetings and issues were discussed with staff on an ad hoc basis only.

• Systems used to monitor the quality of the care and treatment were inconsistent and not being used effectively to improve the service. Clinical audit information reflected a data collection process with no evidence that audits were used to improve the quality of care.

• Data showed patient outcome results were low compared to national outcomes.

• There was a practice nurse vacancy covered by a locum nurse practitioner who spent only five hours per week, two or three times a month in the surgery. This significantly reduced the access for patients to the services of a practice nurse.

• Staff understood and fulfilled their responsibilities to raise safety concerns. However, there was no evidence to show that learning identified as a result of investigations was being recorded or cascaded to staff.

• The practice had a number of policies and procedures to govern activity, but some were overdue a review. Some policy guidance was not in place; this included a consent to treatment policy and guidance in relation to the Mental Capacity Act 2005.

• We were informed by staff that when a patient’s first language was not English, they had used family members, including children to interpret during consultations.

• The practice had a current complaint policy however; responses to complaints were insufficient to demonstrate the action taken or learning to prevent further incidents.

• There was not an effective system in place to ensure patients received appropriate and timely medication reviews.

• Patients were at risk of harm because systems and processes for managing repeat prescriptions were not in place.

• The practice did not have an automated external defibrillator (AED). The decision not to have an AED had not been risk assessed.

• Staff files were inconsistently maintained and had shortfalls in information to demonstrate staff had been safely and effectively recruited and employed.

• Staff appraisals were mainly self-evaluation and did not identify appropriate performance management, learning needs, personal or professional development.

• There was no patient participation group in place. The practice manager explained the practice had tried a variety of ways to encourage patients to participate but had stopped the meetings due to poor attendance.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity. Comment cards were also positive about the standard of care received.

• Staff were aware of their responsibilities in regards to safeguarding patients, with appropriate policy guidance in place. Staff said they had updated training but this could not be verified during the inspection

The areas where the provider must make improvements are:

• Ensure that safety incidents and significant events are investigated and recorded thoroughly and learning disseminated to staff effectively.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Ensure that quality improvement activity, including clinical audits are implemented effectively to improve patient care and treatment.

• Ensure the practice has sufficient numbers of suitably qualified, competent, skilled and experienced clinical staff.

• Implement appropriate policy guidance to ensure safe care and treatment for patients, including Consent and Mental Capacity assessment.

• Ensure that staff training needs are effectively identified and when undertaken, are recorded.

• Ensure staff appraisals are carried out by staff who are competent to do so.

• Ensure an automated external defibrillator (AED) for medical emergencies is available or undertake a risk assessment if a decision is made not to have an AED on the premises.

• Reinstate Patient Participation Group (PPG) meetings, in order to identify and act on patients’ feedback and suggestions about the service.

The areas where the provider should make improvement are:

• Carry out a risk assessment for legionella to demonstrate risks are effectively managed

• Implement  infection control audits to demonstrate effective monitoring of infection control

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 so a rating of inadequate remains 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 varying the terms of their registration within six months if they do not improve.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice