We previously carried out an announced comprehensive inspection at Alderwood Medical Practice, previously registered as Dr A Verma & Dr TM Campbell, on 12 January 2017. The overall rating for the practice was Good with Requires Improvement for providing safe services. The full comprehensive report on the 12 January 2017 inspection can be found by selecting the ‘all reports’ link for Alderwood Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 31 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 12 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found that the practice had not addressed all of the concerns previously identified and therefore continues to be rated as Requires Improvement for providing safe services.

Our key findings were as follows:

• There were systems in place to mitigate risks to patients prescribed high risk medicines.

• Health and safety policies and protocols to identify, assess and minimise risk to patients and staff had been developed but required further improvement.

• The process for documenting the action taken in response to external alerts that may affect patient safety had improved.

• The healthcare assistant was now working under patient specific directions, a written instruction signed by a prescriber for medicines to be administered to a named patient after the prescriber has assessed the patient on an individual basis.

• The practice had reviewed and updated their policy for the safeguarding of vulnerable adults but this required additional information.

• The practice had implemented processes to demonstrate that the physical and mental health of newly appointed staff had been considered to ensure they were suitable to carry out the requirements of their role.

• An effective prescription tracking system to had been implemented to help minimise the risk of fraud.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients. In particular, review and complete a formal risk assessment to demonstrate how risks to patients will be mitigated in the absence of suggested emergency medicines held at the practice and further develop the health and safety risk assessments.

The provider should:

• Date all policies to ensure they are reviewed and updated within an appropriate time frame.

• Review and update the practice’s safeguarding vulnerable adult’s policy to reflect the latest guidance.

• Document actions taken in response to external medicine safety alerts and ensure they are fully documented in patients’ records.

• Submit an application to CQC in relation to the change in GP partnership.

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 of Dr A Verma and Dr T M Campbell on 12 January 2017. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and reported to external agencies when required.
• Required recruitment checks had been made before a member of staff was employed to work at the practice. However, the physical and mental health of newly appointed staff had not been considered.
• The systems in place to mitigate risks to patients who took high risk medicines were not always effective.
• An overarching training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
• Patients said they found urgent appointments were available the same day.
• Feedback from patients about their care was consistently positive and was reflected in the national patient survey results; last published in July 2016.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a written set of objectives and values supported by a written practice development plan that reflected this strategy and ensured the future direction of the practice was monitored and evaluated.
• The practice had visible clinical and managerial leadership. Most governance and audit arrangements were effective but we found some areas that required ongoing review.

The areas where the provider must make improvement are:

• Ensure that systems to mitigate risks to patients prescribed high risk medicines are fully effective.
• Implement patient specific directions for the healthcare assistant.
• Further develop the health and safety policies and protocols to identify, assess and minimise risk to patients and staff using risk assessments and a review of the process for responding to alerts.

The areas where the provider should make improvement are:

• Review the process of responding to alerts to include a record that appropriate actions have been completed.
• Complete the practice policy for the safeguarding of vulnerable adults.
• Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
• Implement an effective prescription tracking system to minimise the risk of fraud.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice