Archived: Droylsden Road Family Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Droylsden Road Family Practice on 21 October 2016. Overall the practice is now rated as inadequate.

The practice had previously been inspected on 8 March 2016. Following this inspection the practice was rated inadequate with the following domain ratings:

Safe – Inadequate

Effective – Inadequate

Caring – Inadequate

Responsive – Inadequate

Well-led – Inadequate

The practice provided us with an action plan detailing how they were going to make the required improvements. In addition, they wrote to us with updates on progression and actions that had been addressed.

A focused inspection took place on the 5th & 7th July 2016, to check that the practice had followed their submitted plan and to confirm that they now met legal requirements with the premises.

Following this re-inspection on 21 October 2016, our key findings across all the areas we inspected were as follows:

• Systems were still at a very early stage of development and had not been fully embedded throughout the practice. A large number of policies had been introduced or were at final review stage awaiting sign off; therefore the impact of their effectiveness could not be fully assessed.
• Patients were at risk of harm because clinical systems and processes were not fully embedded to keep them safe. For example no care plans were in place, this had been previously identified in the March 2016 inspection.
• Patients test results and hospital admissions follow ups were not actioned by clinicians in a consistent way with no clear process to ensure patient safety. We identified patients who had not received information regarding the outcome of their test results from several weeks previously.
• Patients were at risk of harm because of serious inconsistencies in the quality of recordings of consultations between clinicians. For example, a significant long term condition had not been documented in the record of one patient.
• Patient’s referrals were not being processed in a timely manner after consultation.
• Repeat prescriptions, medication reviews and re authorisation checks were not always actioned appropriately by the clinical staff. Administrative staff were given permission to issue prescriptions even if the review dates were overdue.
• The practice did not have a system in place to ensure that all clinical staff, including locum GP’S were kept up to date. The practice did not disseminate NICE guidelines or monitor that they were being followed. Medical alerts were not disseminated and there was no record that they had been actioned appropriately.
• Improvements to cleanliness and hygiene of the premises had been made in that, patient areas were visibly clean and tidy.
• Information for patients was more readily available on the new website. This now provided patients with the opportunity to access services online.
• The practice had a newly formed patient participation group (PPG) and a notice board in the reception area which provided feedback to patients about how the practice had responded to patient concerns and the improvements made.
• The provider was aware of and complied with the requirements of the duty of candour.

The practice did not provide safe or effective care to patients, we found clinical areas where the provider must make improvements, these areas are:

• The provider must ensure that all clinicians undertake care planning for all at risk patients.
• The provider must develop a process to ensure that all clinicians respond in a timely manner to patients changing needs, including clinical reviews on hospital admissions, hospital discharges and patients with a long term condition.
• The provider must ensure all patients’ referrals are actioned within a timely manner.
• The provider must introduce a procedure to ensure all patients test results are followed up and actioned in a timely manner and in a consistent and timely way to ensure patient safety.
• The provider must ensure patient’s consultations notes are up to date, with consultation notes containing adequate patient information to be clear and precise relevant medical information to protect the patient from future risk of harm.
• The provider must follow the prescribing policy and procedure for reviewing and re-authorising repeat medication in a safe and timely manner.
• The provider must have a process to disseminate NICE guidelines and medical alerts to all clinical staff, including locums and keep an auditable trail of any actions taken.

The areas where the provider should make improvement are:

• Follow practice policy when recruitment checks are carried for all new staff.
• Add the full address of the Parliamentary and Health Service Ombudsman( PHSO) in the complaints policy and the patients information leaflet.
• Maintain the new governance systems to ensure integrated fully into the practice.
• Provide all staff with an annual review and appraisal.
• Review and increase the numbers of carers on the practices carers register.
• Continually monitor and maintain the appointment system.

Enforcement action was taken against the provider on the 8th November 2016, when we issued an urgent notice of decision to immediately suspend their registration as a service provider (in respect of all regulated activities for which they are registered) for a period of three months. We took this action because we believed that a person would or might be exposed to the risk of harm if we did not take this action.

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 of this practice on 8 March 2016. Breaches of regulations were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014, Safe care and treatment
• Regulation 15 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014, Premises and equipment.
• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014, Good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to the warning notices we issued. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Droylsden Road Family Practice on our website at www.cqc.org.uk.

Our key findings were as follows:

• Improvements to cleanliness and hygiene had been made following our last inspection and all patient areas were visibly clean and tidy. Also actions had been taken to remove all risk hazards such as; no wires were exposed and had they been boxed off in each room, all metal protruding objects had been removed from the patient waiting area, treatment room one had been fully refurbished with a new plastered wall to remove the damp and full new sink area had been built.
• A new infection control process and policy had been established with a full practice audit completed and actioned. Risk assessments were in place for controlling and preventing the spread of infection in areas of clinical practice.
• There had been a newly fitted fire alarm control panel, fire extinguishers and signs throughout the practice with a newly established policy and procedure.
• Control of substances hazard to health (COSHH) procedures and cleaning schedules had been newly implemented.
• New audits and suitable arrangements had been made for the safe handling of high risk medicines with a policy and process implemented.
• There had been a new clinical governance systems and process introduced. This was at a very early stage of implementation. We saw positive examples of the new system in place in the area of reporting and recording significant events. Also there had been full team meetings where we saw evidence of the new policies being reviewed, amended and signed off.
• Patients summary care records were stored securely with a clear process to reduce the outstanding amount already being actioned. All new patients were summarised within two weeks of being registered.

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 Droylsden Road Family Practice on 8 March 2016. Overall the practice is rated as inadequate.

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

• There was no clinical accountability or responsibility in the running of the practice.
• Patients were at risk of harm because inadequate systems were in place to keep patients safe including those for dealing with fire safety and health and safety of the patients.
• The practice had no infection control process, or any record of annual audits having taken place.
• The premises were dirty and cluttered throughout.
• There were hazards throughout the practice with no risk assessments in place.
• Staff were not clear about reporting significant events, incidents and near misses and there was no evidence of learning and communication with staff.
• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others, either locally or nationally.
• There was no record that staff had received regular mandatory training such as infection control; however there was access to online training available for all staff.

The areas where the provider must make improvements are:

• The provider must introduce clinical protocols and undertake clinical audit, care planning and quality improvements.
• Introduce quality assurance processes to act on and monitor histology and test results.
• Introduce processes and policies to ensure a safe practice environment is maintained with regards to Health and Safety of patients for example risk assessments, COSHH and cleaning maintenance.
• Introduce quality assurance processes for reporting, recording, acting on and monitoring of significant events and medicine management.
• Ensure infection control process and procedures are fully implemented.
• Implement a formal system to ensure all patient records are updated in a timely manner.
• Develop a plan to data summarise all outstanding medical notes.
• Implement processes and update current practice policies to reflect the practice and staff roles accurately.
• Place all clinical medical records into a secure storage.
• Ensure that staff receive appropriate training and supervision to enable them to carry out the duties they are employed to do with a clear record.
• Check all electrical equipment is safe, for example extension leads and plug in heaters.

In addition the provider should:

• Implement a Patient Participation Group (PPG) in order to identify and act on patients’ views about the service.
• Install a doorbell at the front door for wheelchair patients.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice