Dr NHR Simpson's Practice Also known as Dr Simpson & Partners

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr NHR Simpson’s Practice on 24 June 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate in providing safe, effective, responsive and well-led services and requiring improvement for providing caring services. It was also inadequate in providing services for all the population groups.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe, for example, appropriate recruitment and accreditation checks.
• There was no evidence of any induction process for nursing and HCA (Health Care Assistant) staff.
• Staff were clear about reporting incidents, near misses and concerns, however the investigation of such was not sufficient for learning and preventing re-occurrence.
• There was insufficient assurance to demonstrate people received effective care and treatment. For example there was no evidence of practice protocols for the management of illnesses such as hypertension, diabetes, chronic kidney disease or asthma.
• Patients said they felt the practice offered an excellent service and staff were efficient, helpful and caring.
• Urgent appointments were usually available on the day they were requested. However patients said that it was difficult to get through by telephone.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
• The business continuity plan was not personalised to the practice and had no contact details completed should an emergency arise.
• Multi-disciplinary team meetings were not in place to discuss vulnerable adults and children.
• Medication checks were not being evidenced and there were no clear guidelines for staff to work from.
• The incoming mail including correspondence relating to patients was being prioritised by non-clinical administrative staff with no formal process or procedure to work to.
• There had not been an infection prevention control audit since 2012.

The areas where the provider must make improvements are:

Action the provider MUST take to improve:

• Address identified concerns with infection prevention and control practice.
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure staff have appropriate policies, protocols and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice including the Business continuity plan to be updated and personalised to the practice.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.
• Ensure that full investigations of serious incidents are undertaken and actions and lessons learned are taken to prevent reoccurrence. Also to demonstrate candour where necessary.
• Ensure that there is a process for incoming mail that is robust and clinically safe.
• Ensure recruitment arrangements include all necessary employment checks and staff are adequately trained to perform their roles, such as chaperone training and mental capacity training.
• Put systems in place to ensure medications are checked to ensure that drugs are safe and are within the manufacturers expiry dates.
• Update registration details for provider, partners and registered manager.

Action the provider SHOULD take to improve:

• Improve processes for making appointments.
• Ensure complaints and significant events are regularly discussed.
• Multi-disciplinary meetings should commence to discuss the safeguarding of vulnerable patients.
• Ensure there is a policy for the management of Legionella and undertake an assessment of the risk from Legionella.
• Process and policy to identify and monitor risks to patients, staff and visitors to the practice.
• Recall processes to be built and embedded in practice for the management of long term conditions.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice