Archived: The Little Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 30 June 2016. We also carried out a focussed follow-up of this practice on 7th and 13 March 2017.

Breaches of legal requirements were found in relation to governance arrangements within the practice. We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in those warning notices by 30 June 2017. We undertook this focused inspection on 2 August 2017 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.

At the inspection on 2nd August 2017 we found that the requirements of the warning notice had been met.

Our key findings across the areas across the areas we inspected for this focussed inspection were as follows:

• The practice had made considerable improvements since the last inspection.

• We found the practice had made improvements to its system for significant events, near misses and incidents but the system required further development to evidence that all events were captured, fully investigated, learning identified and actions implemented.

• Risks to patients were now assessed and well managed.

• Most patients on high risk medicines had been reviewed, alerts and blood monitoring were in place.

• Considerable improvements had taken place in regard to the system for patients who required a medication review.

• An effective system had been put in place for the monitoring of staff training.

• The practice now had a governance framework in place which supported the delivery of their strategy and good quality care.

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The provider should:

• Continue to embed the system in place for significant events, incidents and near misses.

• Ensure all the actions from the health and safety, premises risk assessments are completed.

• Complete the medication reviews for patients on medicines for high blood pressure and under active thyroid to ensure the safe prescribing and monitoring of continued prescribing of medicines for patients.

• Ensure Care Quality Commission inspection reports are displayed on the practice website.

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 The Little Surgery Stamford on 30 June 2016. The overall rating for the practice was requires improvement .Safe and Well-led were requires improvement. Effective, Caring and Responsive were rated as Good. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Little Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 March 2017 and a further visit on 13 March 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 30 June 2016. This report covers our findings in relation to those requirements, additional improvements made since our last inspection and any areas concerns since the last inspection.

Following the most recent inspection we found that overall the practice was rated as inadequate. We found that both Safe and well-led were now also rated as inadequate.

• Patients were at risk of harm because some of the systems and processes in place were not effective to keep them safe. For example, in the areas of significant events, management of high risk medicines, medication reviews, recall of patients with long term conditions, and staff training.

• Not all risks were assessed and well managed.
• We found that in some cases medication reviews were not being carried out appropriately to ensure the safe prescribing and monitoring of continued prescribing of medicines for patients. Patient care records in relation to some medication reviews were not found to be factually accurate and did not represent the actual care and treatment of patients.
• The system in place to monitor the training of the GPs and staff within the practice was not effective. For example, not all clinical staff had received appropriate training in safeguarding to ensure they were up to date with current procedures.
• Formal governance arrangements needed to be reviewed to ensure they were effective.

The areas where the provider must make improvements are:

• Assess, monitor and improve the quality and safety of the services provided. For example, For example, in the areas of significant events, management of high risk medicines, medication reviews, recall of patients with long term conditions, and staff training

• Assess, monitor and mitigate the risk relating to the health, safety and welfare of service users and others who may be at risk, For example, fire, legionella and electrical safety.

The areas the provider should make improvements are:

• Ensure there is information for carers available in the practice.
• Regularly review standard operating procedures to ensure they remain fit for purpose.
• Implement a lone working policy for the dispensary.
• Perform regular competency assessments for dispensary staff.
• Implement a system for tracking blank prescription forms through the practice in accordance with national guidance.

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