Hook Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Hook Surgery on 8 June 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breaches of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to do all that was reasonably practicable to ensure that sufficient safeguards were in place when prescribing medicines, this included the bulk prescribing of high-risk medicines such as Warfarin, and the lack of formal guidelines for prescribing by the nurse practitioner; that they did not have processes in place to ensure that the temperature of the vaccines refrigerator was monitored on a daily basis and had failed to keep comprehensive records of action taken when the temperature had gone outside of the optimum range; that they did not do all that as reasonably practicable to ensure that patients who failed to collect prescriptions were followed-up; and that they did not have sufficiently robust processes in place to ensure that there was clinical oversight of all hospital correspondence received.

We also found areas where the practice should make improvements. We found that the practice had been recording significant events, but that their records did not always contain sufficient detail; the practice provided training to its staff but processes in place to identify when refresher training was due had not been maintained; at the time of the initial inspection, the practice's Patient Participation Group had been recently restructured and the new group was in the process of becoming fully established; the practice had identified 13 carers, which represented less than 1% of their patient population.

We undertook this focussed inspection on 9 December 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report 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 Hook Surgery on our website at www.cqc.org.uk.

Overall the practice was rated as good following the comprehensive inspection. They were rated as requires improvement for providing safe services. Following the focussed inspection we found the practice to be good for providing safe services.

Our key findings across all the areas we inspected

were as follows:

• There was an effective system in place of reporting and recording significant events.
• The practice’s arrangements for prescribing medicines was in line with guidelines and up to date policies were in place.
• Prescription sheets and pads were stored safely and records were kept of stocks held.
• The practice recorded the temperature of their medicines fridges daily; however, their temperature log did not record full details of action taken when fridge temperatures went out of the optimum range.
• All clinical letters were reviewed by GPs.
• All staff were up to date with mandatory training sessions and processes were in place to flag when training was due.
• The patient participation group continued to meet regularly.
• The practice had identified 13 carers at the time of the initial inspection; however, they felt that this was not a true representation of their carers register and that there had been an error in their data collection. At the time of the follow-up inspection they re-interrogated their patient records system, and we saw evidence that they had 115 carers on their register, which represented 2% of their patient list.

The practice should take action to address the following area:

• They should ensure that full details are recorded of action taken when medicines fridge temperatures go out of the optimum range.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice