The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dosthill Surgery Also known as Wilnecote and Dosthill Surgeries

Overall: Requires improvement read more about inspection ratings

45 Cadogan Road, Dosthill, Tamworth, Staffordshire, B77 1PQ (01827) 283487

Provided and run by:
Wilnecote and Dosthill Surgeries

All Inspections

23 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

When we carried out an unannounced comprehensive inspection of Wilnecote Surgery on 28 September 2015, we found three breaches of legal requirements. As a result, we issued two warning notices in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safe care and treatment.
  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Good governance

We also issued a requirement notice in relation to:

  • Regulation 19 of the Health and Social Care Act 2008(Regulated Activities) 2014. Fit and proper persons employed.

We undertook an unannounced focussed inspection on 17 March 2016 to follow up on the warning notices. Further concerns were identified and the practice was required to complete an urgent response to demonstrate that these concerns had been addressed. A weekly report has been sent to the Care Quality Commission (CQC) since 17 March 2016 to demonstrate that improvements have been sustained.

We undertook another announced comprehensive inspection on 23 May 2016 to check that the practice now met legal requirements. 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 Wilnecote Surgery on our website at www.cqc.org.uk.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

  • The practice had made improvements to the way it acted on patients’ blood test results. Test results were viewed on the same day or next working day and a weekly report, submitted to the CQC since March 2016, showed that test results had been completed by the end of each week.
  • A robust system had been implemented to manage patients on shared care arrangements. However, we saw examples of clinical alerts that had not been acted on to minimise risks to patient safety.
  • A structured approach had been adopted to coordinate patient medication reviews.
  • Patients were seen to be treated with compassion, dignity and respect. However the national GP survey scores relating to care were below local and national averages.
  • The leadership team within the practice did not demonstrate the necessary capability and appropriate knowledge.
  • Patients spoke of good access to appointments with a named GP and there was continuity of care, with urgent appointments available the same day.

There are areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Implement and operate a consistent and effective system for receiving and acting on safety alerts affecting patient safety.
  • Hold appropriate emergency medication in the practice to treat a severe infection in the blood due to meningitis and to treat adverse symptoms from a low heart rate.
  • Ensure that leadership addresses the continued poor performance in meeting the legislative requirements.
  • Demonstrate clinical governance to minimise the risks to patient safety.

In addition the provider should:

  • Ensure that the safeguarding lead is aware of, and follows up on, those patients identified as vulnerable.
  • Ensure infection prevention control audits meet nationally recognised guidelines.
  • Ensure learning outcomes from significant events
  • are understood by appropriate staff.
  • Implement and operate an effective system for receiving and issuing blank prescriptions.
  • Include the next of kin details on the care plans of patients identified as vulnerable and at increased risk of hospital admission.
  • Consider how to improve performance in the national GP patient survey regarding registered patient satisfaction rates in relation to their interactions with GPs.
  • Ensure that clinical judgements such as medicine initiation are not inputted onto the clinical system by non-clinical, non-qualified staff unless in an emergency when a documented reason should be included.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. Remaining in special measures represents a decision by the Care Quality Commission (CQC) that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Special measures will give people 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

17 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

When we carried out an unannounced comprehensive inspection of Dosthill Surgery on 28 September 2015, we found three breaches of legal requirements. As a result, we issued two warning notices in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safe care and treatment.
  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Good governance

We also issued a requirement notice in relation to:

  • Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Fit and proper persons employed.

We undertook an unannounced focussed inspection on 17 March 2016 to follow up on the warning notices. Further concerns were identified and the practice was required to complete an urgent response to demonstrate that these concerns had been addressed. A weekly report has been sent to the Care Quality Commission (CQC) since 17 March 2016 to demonstrate that improvements have been sustained.

We undertook another announced comprehensive inspection on 23 May 2016 to check that the practice now met legal requirements. 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 Dosthill surgery on our website at www.cqc.org.uk .

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

  • The practice had made improvements to the way it acted on patients’ blood test results. Test results were viewed on the same day or next working day and a weekly report, submitted to the CQC since March 2016, showed that test results had been completed by the end of each week.
  • A robust system had been implemented to manage patients on shared care arrangements. However, we saw examples of clinical alerts that had not been acted on to minimise risks to patient safety.
  • A structured approach had been adopted to coordinate patient medication reviews.
  • Patients were seen to be treated with compassion, dignity and respect. However the national GP survey scores relating to care were below local and national averages.
  • The leadership team within the practice did not demonstrate the necessary capability and appropriate knowledge.
  • Patients spoke of good access to appointments with a named GP and there was continuity of care, with urgent appointments available the same day.

There are areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Implement and operate a consistent and effective system for receiving and acting on safety alerts affecting patient safety.
  • Hold appropriate emergency medication in the practice to treat a severe infection in the blood due to meningitis and to treat adverse symptoms from a low heart rate.
  • Ensure that leadership addresses the continued poor performance in meeting the legislative requirements.
  • Demonstrate clinical governance to minimise the risks to patient safety.

In addition the provider should:

  • Ensure that the safeguarding lead is aware of, and follows up on, those patients identified as vulnerable.
  • Ensure infection prevention control audits meet nationally recognised guidelines.
  • Ensure learning outcomes from significant events are understood by appropriate staff.
  • Implement and operate an effective system for receiving and issuing blank prescriptions.
  • Include the next of kin details on the care plans of patients identified as vulnerable and at increased risk of hospital admission.
  • Consider how to improve performance in the national GP patient survey regarding registered patient satisfaction rates in relation to their interactions with GPs.
  • Ensure that clinical judgements such as medicine initiation are not inputted onto the clinical system by non-clinical, non-qualified staff unless in an emergency when a documented reason should be included.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. Remaining in special measures represents a decision by the Care Quality Commission (CQC) that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Special measures will give people 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

17 March 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an unannounced inspection at Dosthill Surgery on 17 March 2015. The inspection was to follow up warning notices we issued after an inspection on 28 September 2015 when the practice was rated as inadequate and placed into special measures.

At our inspection on 28 September 2015, we found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued warning notices in respect of the following breaches of regulations:

Regulation 12: Safe care and treatment

Regulation 17: Good governance

Our follow up inspection on 17 March 2016 was to look at the areas we identified in the warning notices to determine if the required improvements had been made. During the inspection we saw other areas of serious concern.

Our key findings were as follows:

  • Patients’ blood test results were not being actioned in a timely manner. Evidence was seen that 1,314 blood results had not been reviewed, 904 of which were highlighted by the system as abnormal.
  • We reviewed thirteen of the unactioned blood results that were more than one month old. Eight of the 13 patients were at risk of avoidable harm. For example, one patient was at risk of a stroke.
  • Patients on repeat prescription were not managed effectively. For example, a patient on a controlled drug had not had their medication reviewed since 9 July 2014.
  • A review of patient letters found that the processing of correspondence was up to date. However we found a deleted email that had not been not been actioned or attached to the patient record.
  • Patients on high risk medication had been identified and recalled for retest appointments when needed. However medication had been stopped by the practice for two patients with no reasons recorded, no notification to the patient, and no notification to the consultant who had initialised the medication. Evidence sent after the inspection confirmed that one of the patient's had had their medication stopped by a hospital consultant.
  • Staff files contained appropriate checks. For example, proof of professional qualifications, two forms of personal identification.
  • Relevant staff training had been completed or planned.
  • Health and safety improvements had been made following our inspection in September. For example, risk assessments completed included use of visual display units, slips and trips and lone working.

Following the inspection, we wrote to the provider requiring them to take immediate steps to clear the backlog of blood test results, and to put in place a series of measures to ensure patient safety. We reviewed the provider’s response and decided that they had taken sufficient action to maintain patient safety.

As this inspection only focussed on the two warning notices previously issued, the practice’s original rating of Inadequate remains. This will be reviewed at a further comprehensive inspection within two months, when we will also check that the improvements made after this inspection have been maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

28 September 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a short notice announced inspection on 28 September 2015. We inspected both locations Dosthill Surgery and Wilnecote Surgery. We found that the provider was incorrectly registered as they had registered two separate locations. We found that they operate as a main location with a branch surgery with the same patient list, and the governance arrangements managed from Dosthill Surgery. The opening hours of both surgeries were similar and patients were able to make appointments at either surgery to see a GP or a member of the nursing team.

We found both Dosthill and Wilnecote surgery locations to be inadequate in three of the five key domains inspected (safe, effective and well-led). They were good for providing a caring service and responsive service. There were aspects of practice which were inadequate that related to all population groups; it was also therefore inadequate for providing services for the all population groups.

Our key findings were as follows:

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example not all appropriate recruitment checks on staff had been undertaken prior to their employment. Staff who supported patients as a chaperone had not completed chaperone training and non-clinical staff had not had appropriate police checks completed.
  • There was a lack of sufficient quality assurance and governance processes in place to support staff to deliver high quality evidence-based care to patients accessing the service.
  • There was insufficient assurance to demonstrate people received effective care and treatment.
  • There was a lack of appropriate policies or guidance in place to support staff and ensure that risks to patients were identified, monitored and reviewed.
  • Staff were clear about reporting incidents, near misses and concerns but the systems in place were not robust and there was no evidence of learning and communication with staff.
  • There was a leadership structure with named members of staff in lead roles, but limited formal governance arrangements.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity. The Patient Involvement Group reported positively on their engagement and the responsiveness of the practice to their suggestions and surveys.
  • Appointments with both the GP and the nurse were available at short notice, with the waiting time for non-urgent appointments generally around 24 hours. All urgent requests were usually addressed on the day either with a telephone consultation or a face-to-face appointment.
  • We received positive comments from the patients we spoke to during the visit. They were complimentary about all their interactions with staff and felt they dealt with them with compassion, dignity and empathy.
  • All areas of the practice were clean, tidy and well-maintained.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure staff have appropriate and current policies and guidance readily available, in order to carry out their roles in a safe and effective manner, with a system to verify the staff‘s understanding and competency of policies and procedures.
  • Ensure there are robust systems in place to review and monitor patients who may be at risk or vulnerable within the practice population.
  • Take action to ensure patients on disease modifying medicines are monitored and managed by staff qualified and competent to do so.
  • Take action to ensure that all blood results whether within normal ranges or otherwise are reviewed by a suitably qualified, skilled and competent staff member.
  • Take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and necessary employment checks are in place for all staff. Implement systems to be assured that all staff are appropriately registered with their professional bodies.
  • Review its systems for assessing and monitoring the quality of service provision and take steps to ensure risks are managed appropriately.
  • Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
  • Ensure that staff training is effectively recorded and monitored.
  • Accurately register their main and branch location with the Care Quality Commission.

In addition the provider should:

  • Consider implementing a lone worker policy.
  • Ensure policies have a review date and that this is actioned by the review or should change occur.
  • Ensure that practice staff meeting minutes are distributed to all staff members and that staff have the opportunity to add to the meeting agenda.
  • Ensure that staff are aware of the practice mission statement, vision and values.
  • Ensure there is a policy for the management; testing and investigation of legionella (a bacterium found in the environment which can contaminate water systems in buildings).
  • Ensure there is a clear strategy for the future of the practice.

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