We carried out a review of the data available to us about Ibstock House Surgery on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ibstock House Surgery, you can give feedback on this service.
We carried out an announced focused inspection at Ibstock House Surgery on 23 July 2019. This was in response to concerns which had arisen as a result of a serious incident, relating to high risk medicine monitoring and prescribing.
The areas focused on, as part of the inspection, related to the key questions: safe and well led.
We did not rate the practice at this inspection and therefore the rating from the last inspection in June 2017 remains as good.
The purpose of the inspection was to ensure the systems and processes the practice had put in place as a result of the incident were effective and kept patients safe.
At this inspection, we found that the provider had satisfactorily addressed these areas.
We based our judgement of the quality of care at this service on a combination of:
what we found when we inspected.
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.
We found:
The practice had implemented systems and processes to ensure safe care and treatment is delivered to patients.
The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
Governance arrangements were clearly outlined and audit processes were in place to monitor quality and performance.
Details of our findings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
We carried out an announced comprehensive inspection at Ibstock House Surgery on 27 October 2016. The overall rating for the practice was requires improvement. The ratings for providing an effective, caring and responsive service were good but the ratings for providing a safe and well led service were requires improvement as we identified a breach in regulations. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Ibstock House Surgery on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 29 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 October 2016. This report covers our findings in relation to those requirements.
Overall the practice is now rated as good and the ratings for providing a safe and well led service are also good.
Our key findings were as follows:
An action plan had been compiled and completed to strengthen infection control processes. This included the infection control lead nurse attending a training course to support them in their role and infection control audits had been completed for both sites and actions identified in the audit had been addressed.
A log of safety alerts was now kept and actions taken and responsibility for actions were recorded. However we found that there was no evidence of some safety alerts prior to the log being commenced in November 2016 having been acted upon. Following our inspection the practice reviewed all safety alerts from the previous year and acted on them as necessary.
The cold chain policy had been updated and all staff had been made aware of it to ensure they were fully aware of all aspects of the cold chain process and required actions.
We saw one area of outstanding practice:
The practice hired a mini bus twice a week and employed a driver to provide free transport for patients to and from the practice to attend their appointments. The minibus was wheelchair accessible by means of a lift which also allowed patients with limited mobility who may have struggled to use bus steps to access the transport.
The bus could be used by any patients but was generally used by elderly patients who had no other means of getting to the practice, particularly as some areas served by the practice had no public bus service. Other patients who would not have been able to walk the distance to or from a bus stop. due to lack of mobility also benefitted from the service.
Patients were made aware of the service by means of the practice leaflet, the practice website, word of mouth or by staff suggesting it’s use. For example, one patient was phoned by a GP in the morning and assessed as needing to be seen in the practice. The GP communicated with reception to organise a place on the minibus which co-ordinated with an appointment and the patient was seen in the practice two hours later.
The areas where the provider should make improvement are:
Continue to make efforts to further increase the number of carers identified, including young carers.
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Ibstock House Surgery on 27 October 2016. Overall the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
Data from the national GP patient survey showed patients rated the practice lower than others for most aspects of care.
Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons. However we saw no evidence the practice carried out reviews and completed searches on the patient record system to ensure action was taken against the alerts. The practice had recently changed computer systems and it was not possible to review the older alerts.
The practice had recently changed computer systems which meant that at the time of the inspection they had identified 58 patients as carers (0.5% of the practice list). The practice waiting area did not display any support or signposting for carers services.
The premises were visibly clean and tidy. The practice nurse who had been the infection control lead had left the practice and the practice did not have a copy of a recent infection control audit.
Staff at the branch were not able to demonstrate their knowledge of the cold chain procedure. Although temperatures were checked and within the required range the staff we spoke with were unable to explain action they should take for any outside of this range
All staff had received an appraisal within the last 12 months however some of the clinical staff appraisals had been completed without a clinician present.
The areas where the provider must make improvements are:
Ensure infection control audit is completed and any actions identified are addressed.
Ensure all staff that are part of the cold chain process understand the procedure and action that should be taken were necessary.
The areas where the provider should make improvement are:
Embed new process for the management of safety alerts.
Chief Inspector of General Practice