Archived: Clinton Road Surgery

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection on 16 November 2016. This inspection was performed to check on the progress of actions taken following an inspection we made on 3 March 2016. These included gaps in;

• Recruitment and chaperone processes, Disclosure and Barring Service checks or risk assessments for some staff, prescription security and monitoring,

• governance arrangements to review and promote practice specific policies, training was not monitored effectively, continuous clinical and internal audit was not in place,

• recording and managing risks, arrangements to gather feedback from patients, and sharing meetings information.

Following the inspection in March 2016 the provider sent us an action plan which detailed the steps they would take to meet their breaches of regulation. During our latest inspection on 16 November 2016 we found the provider had made the necessary improvements in delivering safe, effective, responsive and well led services.

This report covers our findings in relation to the requirements and should be read in conjunction with the comprehensive inspection report published in May 2016. This can be done by selecting the 'all reports' link for Clinton Road Surgery on our website at www.cqc.org.uk

Following our inspection of Clinton Road Surgery on 16 November 2016, the overall rating for the practice is good.

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 had been implemented for reporting and recording significant events and verbal complaints. This ensured that learning was shared and practise changed to promote continuous improvement. Audits had been carried out to ensure changes made were embedded.

• Risks to patients were assessed and well managed.

• The practice had significantly improved its approach to safety with systems that ensured there was oversight of potential risks and monitoring in place to mitigate these.Systems demonstrated that prescriptions were audited and secure, fire checks were being completed, there was proactive management of staff training and infection control practice. Disclosure and Barring (DBS) checks had been carried out and only named staff with a DBS and training were undertaking chaperone duties. All staff had completed basic life support and Mental Capacity Act training since the last inspection.

• Data published since our last inspection showed that the practice had better oversight of quality outcomes for patients and had improved this by achieving 100% for the year 2015/16. GPs were able to demonstrate increased level of clinical audit, which was positively influencing improved health outcomes for patients.

• 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.
• The practice had reviewed its approach to carers in several ways: New patient registration information asked patients to identify if they were a carer or being cared for. Priority appointments for any patient who was a carer were available. Increased knowledge of and signposting to other services was evident. A member of the PPG had been identified as the carers champion and was working closely with a named member of staff to promote support for carers.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• All 113 patients providing feedback at the inspection, through comment cards and discussions, 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. Additional reasonable adjustments had been put in place to assist patients with limited mobility and visual impairments. For example, braille signage had been put in place throughout the building.
• The leadership structure had been reviewed so that lines of accountability for all clinical and management areas were clearer. Governance arrangements had been strengthened since we last inspected and the practice was able to demonstrate through many examples that this was working effectively. Staff felt supported by management.
• In six months, the practice had set up systems to proactively obtain feedback from staff and patients, which it acted on. The practice had engaged with a group of patients who had joined the newly formed patient participation group (PPG) and a fundraising group had been set up. Eleven patients from the PPG told us they saw their role as a ‘critical friend’ and had been meeting every three weeks to monitor the practices recovery plan to improve the service.
• The provider was aware of and complied with the requirements of the duty of candour.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 Clinton Road Surgery on 3 March 2016. Overall the practice is rated as Inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate fire checks and staff training had been undertaken. Actions identified to address concerns with infection control practice had not been taken. Not all staff had received training in basic life support, and the Mental Capacity Act (2005).

• Staff were able to report incidents, near misses and concerns; however there was no evidence of learning and communication with staff.

• Data showed patient outcomes were low compared to the locality and nationally. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• Appointment systems were working well so patients received timely care when they needed it.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements

The areas where the provider must make improvements are:

• Ensure systems are put in place to ensure the security and monitoring of prescription forms.

• Ensure all staff receive training in infection control and the practice must introduce and undertake a comprehensive infection control audit.

• Ensure systems are put in place so that all staff receive up to date training in fire safety and undertake regular fire drills.

• Ensure systems and processes are established and operated effectively to prevent the possible abuse of service users, including providing up to date safeguarding and Mental Capacity Act 2005 training for all staff.

• Ensure systems and processes are put in place to improve communication between all staff teams; particularly in regard of sharing learning from significant events, complaints, audits and service feedback.

• Ensure measures such as clinical audits and re-audits are put in place to improve patient outcomes.

• Ensure more effective governance arrangements are put in place to monitor and improve the quality of services provided to patients.

The areas where the provider should make improvement are:

• Review systems to identify record and support patients who are also carers.

• Review systems for recording verbal complaints to ensure themes are identifiable and appropriateness of responses can be audited.

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.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice