28 June 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at the provider address of Dr Vivian Ding, Bursledon Surgery, The Lowford Centre, Portsmouth Road, Lowford, Southampton, Hampshire, SO31 8ES on 28 June 2016.
The registered location for this provider is no longer operational and all care and treatment takes place at this address. The provider has been informed to apply for amendment to the registration.
Overall the practice is rated as Inadequate.
Our key findings were as follows:
-
Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff. When incidents and complaints had been identified reviews and investigations were not thorough enough.
-
Staff had not been trained in how to safeguard children and vulnerable adults from abuse.
-
There were no processes in place for receiving and responding to medicine and safety alerts.
-
Robust recruitment processes were not in place and appropriate checks were not carried out for all staff.
-
Staffing levels were not always adequate to ensure that all care and treatment was delivered in a timely way.
-
Staff had not received training which was relevant to their roles.
-
There was no process in place for staff meetings, appraisals and clinical supervision.
-
Measures to monitor and improve patient outcomes were inconsistent. Limited audits were undertaken to support quality improvement. The practice did not compare its performance to others or shared learning internally.
-
There was no governance structure in place supported by policies and procedures. Staff were unclear about what policies were in place and were not always able to locate them.
-
Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
Importantly, the provider must:
-
Ensure there are processes for sharing of learning as a result of significant events, incidents and near misses.
-
Ensure recruitment records include all necessary employment checks for all staff.
-
Ensure staffing is adequate in order to ensure there are no delays to patients receiving appropriate care.
-
Ensure all staff have received the relevant training for their role.
-
Ensure patient complaints are reviewed and responded to.
-
Ensure there are formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
In addition the provider should:
Ensure patient information is in formats suitable for the patient group.
-
Review systems for identifying patients who are also carers and provide them with sufficient support and information.
-
Review the complaints received by the practice and develop systems to analysis themes and trends and share learning with relevant staff.
I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.
Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.
Special measures will give patients 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