Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Abbots Bromley Surgery on 14 July 2015. The overall rating for the practice was good with requires improvement in providing a well led service. The practice was served Requirement Notices in Regulation 17 Health and Social Care Act (Regulated Activity) Regulations 2014, Good Governance and Regulation 18, Staffing. The full comprehensive report on 14 July 2015 inspection can be found by selecting the ‘all reports’ link for Abbots Bromley Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 6 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation identified in our previous inspection on 14 July 2015. This report covers our findings in relation to those requirements.

We found these arrangements had significantly improved when we undertook a comprehensive follow up inspection on 6 July 2017. The practice is now rated as good for being well-led.

Overall the practice is rated as good with outstanding in the population group of patients with a long term condition.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with 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.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Report all incidents including dispensers reporting GP prescribing errors.

• Safeguard the medicines and vaccine fridges so they cannot be inadvertently unplugged.

• Complete a general risk assessment of the practice.

• Implement a system to log the action taken by the practice in response to alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).

• Update the practice business continuity plan to include contact details.

• Update non clinical staff records to include their full immunity status.

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 Abbots Bromley Surgery on 14 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and responsive services and requires improvement for well led services. It was good overall for providing services for the following population groups; older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• The practice had not reviewed all past significant events to identify any themes or trends of each event and to show that any action taken had been appropriate and had prevented reoccurrence.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• 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.
• Patients said they liked the open access system which enabled them to have a consultation with a named GP or practice nurse and that there was continuity of care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had limited formal governance arrangements. For example, there was no governance or management oversight in place to ensure all staff received regular fire awareness training or written evidence seen of fire drills to ensure staff acted in accordance with fire regulations.

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

Importantly the provider must:

• Ensure effective formal governance systems and arrangements are in place for monitoring, updating and managing: staff training, recruitment, policies and procedures and health and safety.
• Ensure checks are made on the current training status of all staff.
• Have governance arrangements in place to ensure all staff receive regular fire awareness training and regular fire drills take place so that staff act in accordance with fire regulations.

Importantly the provider should:

• Continue to review recruitment procedures to ensure that all staff who are involved in the direct care of patients including chaperone duties are risk assessed to determine if a Disclosure and Barring Service (DBS) check is required.
• Ensure a copy of the latest infection control audit with any action points shared and made accessible to staff.
• Ensure all staff have an awareness of the Mental Capacity Act.
• Ensure all staff are aware of the practice policies and procedures which include whistleblowing and safeguarding.
• Consider introducing regular formal practice meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited Abbots Bromley surgery to establish that the needs of people using the service were being met. On the day of the inspection we spoke with six patients, eight staff members. The people we spoke with were all complimentary about the service. One patient said, “I can’t speak highly enough of the staff and the practice”.

The practice had a dispensary for prescriptions. We saw that the provider had appropriate arrangements in place to manage medicines. This meant that patients were protected against the risks associated with medicines. Patients told us that they received care, treatment and support that met their needs. They told us, and we observed that care and treatment was provided in a pleasant, clean and hygienic environment.

Staff must be appropriately supported, trained and supervised in delivering care and treatment to patients who used the service. Staff told us they had annual appraisals and that training was available. This included training in protecting vulnerable adults and children.

As part of the inspection we spoke with the Patient Participation Group (PPG). PPGs are an effective way for patients and GP surgeries to work together to improve the service and to promote and improve the quality of the care. We saw that patient’s views and experiences were taken into account in the way that the service was provided. Patients had been invited to comment on the quality of the service via a satisfaction survey.