Archived: Abbotsbury Road Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Abbotsbury Road Surgery on 10 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Abbotsbury Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 July 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 10 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There are effective systems for infection prevention and control in place, including arrangements for checking and recording the immunity status of staff.
• There is a safe system in place for medicines management including addressing MHRA drug safety alerts and NICE guidance; safe prescribing, including where any errors are identified and for prescribing of high risk medicines; written authorisations for Patient Specific Directions; and ensuring the security of blank prescription paper.

• There are effective arrangements for quality improvement and governance, including those for infection control; medicines management; and the recruitment, training and appraisal of staff.
• Information regarding patients care and treatment is responded to and acted upon in a timely way.
• Quality improvement initiatives are effective and there is shared learning with staff when events, issues and concerns arise.
• There is effective record keeping in relation to persons employed and the management of regulated activities.
• There are safe systems in place for staff to receive appropriate support, including regular appraisal; and training, including in basic life support, safeguarding (children and adults), infection control, fire safety and information governance, as necessary to enable them to carry out the duties they are employed to perform.

• Arrangements are in place to enable learning from complaints is shared with staff.

However, there were areas of practice where the provider should make improvements:

• The provider should ensure all staff complete planned training and appraisals.

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 Abbotsbury Road Surgery on 10 January 2017. 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. However, we found gaps in the arrangements for receiving and implementing medicine safety alerts.
• Although risks to patients were assessed and managed we found that some systems were not implemented well enough to keep patients safe. For example, no audit of infection prevention and control had been carried out and we found gaps in the records of staff recruitment checks.
• Staff assessed patients’ needs and delivered care in line with evidence based guidance. However, the arrangements for receiving and circulating National Institute for Health and Care Excellence (NICE) guidance were not implemented consistently.
• Staff told us they were trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, there was no record of up to date staff training or appraisal.
• 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. The practice actively reviewed complaints and how they were managed and responded to and made improvements as a result. However, learning was not shared with all staff.
• Patients said they found it easy to make an appointment with a named GP and 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.
• We saw evidence of high performance against the Quality and Outcomes Framework (QOF) and low exception reporting.
• The practice used innovative and proactive methods to improve patient outcomes, working closely with other local providers to share best practice and ensure they met patient’s needs. For example, patients benefited from the services of the Weymouth Elderly Care Scheme (WECS); and access by referral to the intermediate care hub provided from the local community hospital.
• There was a leadership structure in place, following significant recent changes; and staff felt supported by management. Staff told us there was an open, honest and positive culture in the practice, with positive values demonstrated by all.
• The practice proactively sought feedback from patients, which was positive and it acted on suggestions for improvement.
• We saw that access to policies and procedures was readily available to all. The practice had a documented business action plan. There were business development meetings that were informal and not minuted.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice formed part of the Weymouth Elderly Care Scheme (WECS) that provided support to patients in local nursing and residential care homes and other housebound patients requiring home visits. The practice funded this service along with four other local GP practices to provide dedicated GPs and a nurse practitioner. This ensured every patient received pro-active care through weekly visits, including reviews of patients, medication and care plans. Feedback to the practices from the nursing homes involved showed improvements in the quality of care since WECS started in April 2015. For example, 88% of the homes found it significantly easier to get queries answered and patients reviewed compared with 37% prior to WECS; and 88% of the homes felt the patients received significantly better care, compared with 69% prior to WECS.

The areas where the provider must make improvement are:

• Ensure there are effective systems for infection prevention and control in place, including the arrangements for checking and recording the immunity status of staff.
• Ensure there is a safe system in place for medicines management including addressing MHRA drug safety alerts and NICE guidance; safe prescribing, including where any errors are identified and for prescribing of high risk medicines; written authorisations for Patient Specific Directions; and ensuring the security of blank prescription paper.
• Ensure arrangements for quality improvement and governance are effective, including those for infection control; medicines management; and the recruitment, training and appraisal of staff.
• Ensure information regarding patients care and treatment is responded to and acted upon in a timely way. Also to ensure clinical improvement initiatives are effective and that there is shared learning with staff when events, issues and concerns arise.
• Ensure there is effective record keeping in relation to persons employed and the management of regulated activities.
• Ensure there are safe systems in place for staff to receive appropriate support, including regular appraisal; and training, including in basic life support, safeguarding (children and adults), infection control, fire safety and information governance, as necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvement are:

• Review arrangements to enable learning from complaints is shared with staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice