18 October 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Northbourne Surgery on 18 October 2016. This inspection was undertaken following the period of special measures. Overall the practice is now rated as requires improvement.
Following the inspection in March 2016 the practice was rated as inadequate overall. The practice was inadequate in safe, effective, responsive and well led; and requires improvement in caring. Two warning notices were served which related to the safe care and treatment of patients and good governance of the practice. We carried out an inspection in July 2016 to assess the improvements needed as identified in the warning notices. The Care Quality Commission was satisfied that the areas within the warning notices were addressed adequately.
As part of this inspection in October 2016 we completed a comprehensive inspection and in particular reviewed the areas which did not meet the regulations following our inspection in March 2016 which were:
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There was a lack of systems to ensure there were appropriate staff trained and checked as suitable to act as chaperones.
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Investigation results and other reports were not reviewed and acted upon in a timely way.
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Patients on high risk medicines did not have these reviewed at regular intervals with required blood tests being carried out, to ensure they were being prescribed appropriately.
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Processes for medicines management including handling, administration, storage and prescription did not protect patients from harm.
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Infection control processes and cleaning regimes of equipment and the premises did not protect patients form harm.
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Checks and storage of emergency equipment and medicines were not effective and placed patients at risk of harm.
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There was a lack of formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. This placed patients and others at risk of harm. This included managing significant events, incidents and near misses; systematic updating of policies and procedures to ensure they were current and relevant; ensuring there were suitable numbers of staff who were competent to carry on the regulated activities; engaging with staff and patients about how the practice was run; and ensuring the complaints system was accessible for all patients and concerns were responded to in a comprehensive manner.
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Patients were not proactively engaged in their care and treatment and appointments were not tailored to meet patient need.
The key findings from this inspection are:
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Significant input had been made to the running of the practice to make improvements to the governance and safe service for the benefit of patients.
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Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
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A programme of appraisals had been put in place and appraisals had been carried out for all staff.
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Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
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Recruitment processes were in line with the requirements of the regulations and we found all necessary checks had been made and recorded prior to a member of staff commencing employment.
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Emergency equipment and medicines were suitable for use and regular checks were in place.
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The infection control processes were now in place, which included maintaining records and audits of cleaning regimes to ensure patients were protected from harm.
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Governance arrangements had been reviewed and systems and processes were in place for assessing and monitoring risk and the quality of the service provision. These included managing significant events and complaints; reviews of policies and procedures and proactive engagement with staff and patients on the running of the service.
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The practice had good facilities and was well equipped to treat patients and meet their needs.
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There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff which it acted on.
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The provider was aware of and complied with the requirements of the duty of candour.
The areas where the provider should make improvement are:
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Continue to make sure the signing in book is completed by all staff or make other arrangements to confirm who is in the building.
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Continue to review patients on an individual basis prior to excepting them, to improve exception reporting rates for the Quality and Outcomes framework and to demonstrate effective care is provided.
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Review the use of patients only lancets, which are used when taking blood for blood sugar levels, and replace with single use items to minimise risk of infection.
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Continue to provide opportunities for patients to provide feedback on service provision.
The full reports published on 5 May 2016 and September 2016 should be read in conjunction with this report.
I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service. We will re-inspect the practice within one year.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice