Grayshott Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grayshott Surgery on 1 March 2016. The practice had been rated as good for effective, caring and responsive. However, the practice required improvements in the safe and well led domains. After the comprehensive inspection in March, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following, the provider must:-

• Ensure that regular fire alarm checks are carried out and documented.
• Ensure that health and safety checks for the building and equipment are carried out and documented in line with practice policy.
• Investigate ways to re-establish a patient participation group to provide patient input to the practice.
• Review how learning is shared across the practice. For example from significant events and complaints. Ensure clear communication procedures are in place to ensure all relevant staff are aware of learning from events. Ensure a written record is kept of all verbal complaints so trends can be reviewed and analysed.
• Ensure that records are kept of all training completed by staff.

In addition the provider should:

• Review the training policy to show what training is required for each staff group and when refresher training is required.
• Ensure that recruitment reference checks and disclosure and barring service (DBS) checks are completed in line with practice policies. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Ensure that hand written prescription pads are kept secure at all times when taken off site, and that usage is monitored and recorded.

We undertook this announced focused inspection on 5 October 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. We found that the provider was now meeting all requirements and is rated as good under the safe and well led domains.

This report only covers our findings in relation to those requirements. We found:

• Fire alarms were now checked weekly and a full fire evacuation had taken place, with another planned for October 2016.
• A electrical installation condition check had been completed in June 2016 which showed no concerns. Non clinical electrical items had also been PAT (portable appliance test) tested and the practice had plans in place for this to be repeated every two years (clinical electrical equipment was tested yearly).
• A patient participation group (PPG) had been started and we saw evidence of meetings that had taken place. The PPG had produced a leaflet which contained information about the role of the PPG to try and help recruit other patients.
• Significant events and complaints were now routinely discussed during informal daily meetings and at monthly meetings with the GP’s and nurses. We saw evidence of shared learning and saw minutes of meetings where these were discussed. The practice also reviewed all significant events and complaints on a yearly basis to re-enforce any learning and look for any trends. Verbal complaints were also being recorded and were reviewed by the practice manager.
• A new training tracker on the practices computer system had been introduced. This allowed staff members to log on to their own profile and review the dates of their training. The practice manager was able to review all staff members accounts to ensure that required training had been completed and retained copies of their certificates.

In addition we saw evidence that the provider had:

• Introduced a new training tracker which enabled staff members to know when their mandatory training needed to be renewed.
• Ensured that recruitment checks included completing a risk assessment as to if a DBS check was required for individual roles and where required DBS checks had been completed.
• Reviewed prescription pad monitoring and had a system in place to track prescriptions pads when taken off site. Pads were kept secure at all times.

This report should be read in conjunction with the last report from 1 March 2016. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

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 at Grayshott Surgery on 1 March 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 an effective system in place for reporting and recording significant events.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate building safety checks on the fixed wiring and portable appliances had not been undertaken in the last few years.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 found it easy to make an appointment with a named GP and that 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.
• The practice did not have a patient participation group.
• The practice did not have systems and processes in place to ensure learning from significant events and complaints was shared.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice employed two GPs and a practice nurse solely dedicated to visiting patients in the large care homes in the practice area. These GPs specialised in working with older people and this meant the patients benefitted from more specialised care and continuity of care. The practice nurse ran long term condition clinics at the care homes, which helped patients and care home staff proactively manage patient’s medical needs. This dedicated support for the care homes ensured patients’ medical needs were carefully monitored.

The areas where the provider must make improvement are:

• Ensure that regular fire alarm checks are carried out and documented.
• Ensure that health and safety checks for the building and equipment are carried out and documented in line with practice policy.
• Investigate ways to re-establish a patient participation group to provide patient input to the practice.
• Review how learning is shared across the practice, for example from significant events and complaints. Ensure clear communication procedures are in place to ensure all relevant staff are aware of learning from events. Ensure a written record is kept of all verbal complaints so trends can be reviewed and analysed.
• Ensure that records are kept of all training completed by staff.

In addition the provider should:

• Review the training policy to show what training is required for each staff group and when refresher training is required.
• Ensure that recruitment reference checks and DBS checks are completed in line with practice policies.
• Review the high level of exception reporting in the Quality and Outcomes Framework (QOF) and the practice performance for monitoring the blood pressure of patients with hypertension.
• Ensure that hand written prescription pads are kept secure at all times when taken off site, and that usage is monitored and recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice