Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Garden Park Surgery on 29 April 2016. Overall the practice is rated as inadequate.
Our key findings were as follows:
- Patients were at risk of harm because the systems and processes in place were ineffective and were not implemented in a way that kept them safe. For example, we found significant concerns in relation to medicines management and infection control arrangements.
- There was insufficient evidence that the practice carried out assessments and treatment in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
- The outcomes of patients’ care and treatment was not always monitored regularly. Clinical audits were not routinely carried out to improve care and treatment.
- Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when things went wrong, lessons learned were not communicated widely enough to support improvement.
- Staff had not all received all of the training necessary to carry out their roles effectively.
- Patients said they were treated with compassion, dignity and respect and 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 were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
- There was a leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
- Staff throughout the practice worked well together as a team.
The areas where the provider must make improvements are:
- Implement effective arrangements to assess the risk of, prevent, detect and control the spread of healthcare related infections.
- Ensure appropriate arrangements are in place for the proper and safe management of medicines; including ensuring all medicines are in date and fit for purpose, monitoring the temperatures of the refrigerators used to store vaccines and maintaining records of blank prescription form serial numbers.
- Ensure all medical equipment, such as needles and syringes in the practice is within expiry date and fit for purpose.
- Provide care and treatment in a safe way, including ensuring that a minor surgery log is maintained, consent to minor surgery is obtained and documented and clinical samples are sent for analysis following minor surgical procedures.
- Ensure that the quality and safety of services is assessed, monitored and improved, including the development of a continuous programme of clinical and internal audit.
- Ensure staff receive appropriate support, including appraisal and training relevant to their role.
- Ensure relevant pre-employment checks are carried out on staff, including those who act as chaperones.
- Put systems in place to check that clinical staff are registered with the appropriate professional body.
In addition, the provider should:
- Review the arrangements to enable patients to summon support to access the branch surgery.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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 to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice