Alton Surgery in Alton, Stoke On Trent is a Doctors/GP specialising in the provision of services relating to diagnostic and screening procedures, family planning services, maternity and midwifery services, services for everyone, surgical procedures and treatment of disease, disorder or injury. The last inspection date here was 1st February 2019
Alton Surgery is managed by Alton Surgery.
Contact Details:
Address:
Alton Surgery Hurstons Lane Alton Stoke On Trent ST10 4AP United Kingdom
We previously carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. The overall rating for the practice was good with requires improvement in providing safe services. As a result we issued two requirement notices in relation to safe care and treatment and fit and proper persons employed. We carried out an announced focused inspection on 17 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the regulation breaches. We found that there were ongoing breaches of these regulations and a further breach in staffing. The overall rating remained good with requires improvement in safe services. The reports on the 13 June 2017 and 17 October 2017 can be found by selecting the ‘all reports’ link for Alton Surgery on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 16 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 October 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is now rated as good with requires improvement in well led services.
Our key findings were as follows:
There was a system in place for reporting and recording significant events. Staff understood their duty to raise concerns and report incidents and near misses. However, opportunities to improve identified ongoing errors had not been fully explored or addressed.
Non-clinical staff had not received training to identify the rapidly deteriorating patient or the actions to take.
Staff understood their responsibilities in safeguarding children and vulnerable adults from the risk of abuse. The practice told us they held three monthly safeguarding meetings at the practice to discuss safeguarding concerns, however the outcome of these meetings was not recorded.
There were standard operating procedures (SOPs) to support the governance and effectiveness of the practice’s dispensary and openness and honesty in the reporting of dispensing errors. However, opportunities to reduce errors were not always taken.
Staff were aware of current evidence based guidance.
A formal system to ensure that professional registrations were in date had been implemented.
A system of support and mentorship for nurses that prescribed had been implemented.
Staff involved and treated patients with compassion, kindness, dignity and respect. The practice achieved high levels of patient satisfaction which were above local and national averages in all areas of their performance.
Patients found the appointment system very easy to use and reported that they were able to access care when they needed it.
The practice worked proactively with the patient participation group to meet the needs of their patients.
There were clear responsibilities, roles and systems of accountability to support governance. However, policies and practice administration did not always provide assurance they were operating as intended.
The service was not always transparent, open and honest when sharing information with the Care Quality Commission.
However, there were areas of practice where the provider needs to make improvements.
The provider must:
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
In addition the provider should:
Document the three monthly safeguarding meetings held at the practice to provide an audit trail of concerns and action taken.
Provide non-clinical staff with training to identify the rapidly deteriorating patient and the actions to take.
Letter from the Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. The overall rating for the practice was good with requires improvement in providing safe services. As a result we issued two requirement notices in relation to:
Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.
Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Fit and proper persons employed.
The full comprehensive report on the 13 June 2017 can be found by selecting the ‘all reports’ link for Alton Surgery on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 17 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 13 June 2017. This report covers our findings in relation to those requirements.
Overall the practice is now rated as good with requires improvement in providing safe services.
Our key findings were as follows:
Staff had received appropriate mandatory training to enable them to carry out their duties safely.
Some improvements had been made to protect patients from potential health care associated infections by the provision of immunisations for clinical staff and appropriate screening.
Staff were aware of the manufactures’ temperature range guidelines in which medicines must be stored and the action to take to address any issues identified.
A formal system of support and mentorship for nurses who prescribed had not been implemented.
There had been some improvements in the recruitment information held on staff. However, gaps such as a formal system for ensuring the monitoring of up to date professional registrations of clinical staff was not in place.
A risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury had not been completed. However, a mercury spillage kit had been purchased.
The practice had reviewed the range of medicines they held to treat emergency conditions to include for example, a medicine to treat epileptic seizures.
A comprehensive business continuity plan for major incidents had been developed.
However, there were 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, risks identified at our previous inspection were not risk assessed until the day of this inspection. A risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury had not been completed.
Ensure persons employed in the provision of the regulated activity receive the appropriate support, professional development and supervision necessary to enable them to carry out the duties.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
At our previous inspection on 13 June 2017, we rated the practice as requires improvement for providing safe services. This was because:
The registered person had not ensured that specified recruitment information was available regarding each person employed.
The registered person had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment.
At this inspection we found ongoing gaps in specified recruitment information regarding each person employed and action to mitigate risks had not been taken or was not taken until the day of our inspection.
At our previous inspection we also advised that the provider should:
Complete a risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury.
Introduce a formal system of support and mentorship for nurses who prescribe.
Neither of these two recommendations had been implemented.
Consequently, the practice is still rated as requires improvement for providing safe services.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
Staff were aware of current evidence based guidance.
Systems were not in place to protect patients from potential health care associated infections.
Some staff were not aware of the manufactures’ temperature range guidelines in which medicines must be stored. Action had not been taken immediately to address issues identified.
Specified recruitment information was not available regarding every person employed at the practice.
Some staff had not received the appropriate mandatory training identified by the practice to enable them to carry out their duties.
Risk assessments of the emergency medicines that should be held at the practice had not been completed to demonstrate how patients would be kept safe in the absence of several emergency medicines.
A comprehensive business continuity plan for managing major incidents was not in place.
A risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury had not been completed.
A formal system of support and mentorship for nurses who prescribe was not in place.
Feedback from patients about their care was very positive.
Results from the national GP patient survey published in July 2016 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. It also showed that patient’s satisfaction with how they could access care and treatment was significantly higher than local and national averages.
Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
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 the 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.
We saw two areas of outstanding practice:
The practice had won an award from the National GP Patient Survey achieving the highest patient satisfaction ratings in England. The practice had achieved 100% patient satisfaction in many areas of their performance.
Data showed 100% satisfaction with patient access to appointments. As a result of the practice’s approach to offering quick and easy access to appointments they had the lowest A&E attendance rate within GP opening hours within the local Clinical Commissioning Group (CCG). Data over three years showed a consistent year on year decrease in this rate.
The areas where the provider must make improvement are:
Ensure that systems are in place to protect patients from potential health care associated infections by the provision of immunisations for staff, risk assessments and appropriate screening.
Ensure that staff are aware of manufactures’ temperature range guidelines in which medicines must be stored and that action is taken immediately to address any issues identified.
Ensure specified recruitment information is available regarding each person employed.
Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out their duties.
Introduce systems to risk assess the emergency medicines that should be held at the practice.
Develop a comprehensive business continuity plan for major incidents.
The areas where the provider should make improvement are:
Complete a risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury.
Introduce a formal system of support and mentorship for nurses who prescribe.
We previously carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. The overall rating for the practice was good with requires improvement in providing safe services. As a result, we issued two requirement notices in relation to safe care and treatment and fit and proper persons employed. We carried out an announced focused inspection on 17 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the regulation breaches. We found that there were ongoing breaches of these regulations and a further breach in staffing. The overall rating remained good with requires improvement in safe services. We carried out an announced comprehensive inspection on 16 March 2018 and found all of the required improvements had not been made. We rated the practice good overall and requires improvement in well-led. We issued a requirement notice in relation to good governance. The reports on the 13 June 2017, 17 October 2017 and 16 March 2018 can be found by selecting the ‘all reports’ link for Alton Surgery on our website at
We carried out an announced focused inspection at Alton Surgery on 15 January 2019 to ensure that the required changes had been made.
We based our judgement of the quality of care at this service on a combination of:
•what we found when we inspected
•information from our ongoing monitoring of data about services and
•information from the provider, patients, the public and other organisations.
We rated this practice as good overall.
We found that:
Opportunities to improve ongoing errors, identified through the significant events process had been explored and addressed and learning shared with staff.
A system to assess the competency of unqualified staff that assisted in the dispensary had been put in place.
A system to ensure that standard operating procedures were adhered to for the dispensing of medicines in dosette boxes had been put in place.
Policies had been updated and information contained within them aligned with other resources.
Safeguarding meetings were documented and appropriate information was recorded in patients’ records.
Non-clinical staff had received training to identify the rapidly deteriorating patient and the actions to take.
The practice had not submitted a notification to Care Quality Commission (CQC) regarding an incident they had reported to the police.
The areas where the provider should make improvements are:
Review the Care Quality Commission (Registration) Regulations 2009 to support their understanding of incidents that are notifiable to the CQC.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
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