Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Angel Hill Surgery on 4 October 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing effective and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement. The full comprehensive reports on the 4 October 2016 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Angel Hill Surgery on 26 June 2017.The practice was rated as good for providing effective, caring, responsive and well led services and requires improvement for providing safe services. Overall the practice was rated as good. The full comprehensive reports on the 26 June 2017 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We undertook a desk based inspection on 8 January 2018 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 26 June 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, and good for providing safe services.

Our key findings from this inspection were as follows:

• The practice used a local taxi company to provide a medicine delivery service to housebound patients. The practice had undertaken a risk assessment and had appropriate policies and monitoring in place.
• Medical equipment had been calibrated and the practice had a system to alert them when this needed to be completed again.
• The arrangements for the security of the dispensary ensured that medicines were kept secure and only accessible to authorised staff. The practice was based in a listed building and architect plans had been submitted to the council planning office, and a response was being awaited by the practice, in order to further improve the security of the dispensary.
• The practice had continued to explore improvements to the arrangements for the security of the dispensary to ensure medicines were kept secure and accessible only to authorised staff.
• Infection control training had been completed by all staff, including dispensary staff.
• There was an effective and embedded process for reviewing, sharing and acting upon all National Institute for Health and Care Excellence (NICE) evidence based guidance within the practice. Lead clinicians were responsible for discussing evidence based guidance at educational meetings and we saw evidence to demonstrate this. The practice regularly audited that NICE evidence based guidance was being implemented.

The areas where the provider should make improvement are:

• Continue to explore improvements to the arrangements for the security of the dispensary to ensure medicines are kept secure and accessible only to authorised staff.

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 Angel Hill Surgery on 4 October 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing effective and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement. The full comprehensive reports on the 4 October 2016 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Angel Hill Surgery on 26 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 an effective system in place for reporting and recording significant events.
• Patient safety alerts were logged, shared and initial searches were completed and the changes effected.
• Risks to patients were generally assessed and managed, however the calibration of medical equipment, which was due in October 2016 had not been undertaken and the arrangements for the delivery of medicines by a taxi company had not been risk assessed.
• Improvements had been made to ensure that patients had received appropriate monitoring and review before high risk medicines were prescribed. In addition, changes to patients’ medicines following discharge from hospital and outpatient appointments, were undertaken following instruction from the GP, and prescriptions were reviewed and signed by the GP before they were given to the patient.
• The arrangements for the security of the dispensary did ensure that medicines were kept secure and only accessible to authorised staff. The practice was based in a listed building and architect plans had been submitted to the council planning office, and a response was being awaited by the practice, in order to further improve the security of the dispensary.
• Improvements had been made in relation to infection control, including the identification and training of lead nurses, updated policies and audits with evidence of improvement. Infection control training had been scheduled for all staff although this had not yet been completed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There was scope to embed the newly established process to ensure that all National Institute for Health and Care Excellence (NICE) audits were repeated as appropriate.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However not all staff we spoke with understood the relevant consent and decision making guidance.
• The majority of patients reported that 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 improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients said they were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. Three patients reported that there was often a wait to get through on the telephone in the mornings. The practice were aware and had taken actions to try to address this.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure with a relaxed and friendly management style, and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvement are:

• Continue to explore improvements to the arrangements for the security of the dispensary to ensure medicines are kept secure and accessible only to authorised staff.
• Ensure that infection control training is completed by all staff.
• Embed the newly established process to ensure that all National Institute for Health and Care Excellence (NICE) audits are repeated as appropriate.

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 Angel Hill Surgery on 4 October 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing effective and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement. The full comprehensive reports on the 4 October 2016 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Angel Hill Surgery on 26 June 2017.The practice was rated as good for providing effective, caring, responsive and well led services and requires improvement for providing safe services. Overall the practice was rated as good. The full comprehensive reports on the 26 June 2017 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We undertook a desk based inspection on 8 January 2018 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 26 June 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, and good for providing safe services.

Our key findings from this inspection were as follows:

• The practice used a local taxi company to provide a medicine delivery service to housebound patients. The practice had undertaken a risk assessment and had appropriate policies and monitoring in place.
• Medical equipment had been calibrated and the practice had a system to alert them when this needed to be completed again.
• The arrangements for the security of the dispensary ensured that medicines were kept secure and only accessible to authorised staff. The practice was based in a listed building and architect plans had been submitted to the council planning office, and a response was being awaited by the practice, in order to further improve the security of the dispensary.
• The practice had continued to explore improvements to the arrangements for the security of the dispensary to ensure medicines were kept secure and accessible only to authorised staff.
• Infection control training had been completed by all staff, including dispensary staff.
• There was an effective and embedded process for reviewing, sharing and acting upon all National Institute for Health and Care Excellence (NICE) evidence based guidance within the practice. Lead clinicians were responsible for discussing evidence based guidance at educational meetings and we saw evidence to demonstrate this. The practice regularly audited that NICE evidence based guidance was being implemented.

The areas where the provider should make improvement are:

• Continue to explore improvements to the arrangements for the security of the dispensary to ensure medicines are kept secure and accessible only to authorised staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection on 27 February 2014, we found the service did not have adequate processes in place to ensure the safe management of medicines. In addition we found that not all staff had received the support they should, such as individual appraisals or essential training.

We visited Angel Hill surgery on 8 July 2014 to check that the compliance actions set following our inspection on 27 February 2014 had been completed. We met with the practice manager and spoke with the lead dispenser of medication. We did not speak with patients on this occasion, but did include their comments as part of the original inspection.

There were systems in place to audit the expiry dates and usage of medications. We found the provider had taken action to ensure the safe storage and disposal of controlled drugs. These are medicines controlled under the Misuse of Drugs legislation. In addition medicines were dispensed, stored and recorded correctly. Improvements had also been made to ensure the safe keeping of refrigerated medicines and medication used by the practice nurses during their clinics.

Nursing staff had received an annual appraisal. Staff had received training required by the provider and were supported to complete further professional development when appropriate to do so.

During our inspection we spoke with seven people who used the service. All of the people we spoke with were positive about the service. One person we spoke with told us, “I’ve never had a bad experience here. They always give me a good service.” Another person told us, “I’ve always really liked it and I have never had any problems.”

We found care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. We saw there were arrangements in place to deal with foreseeable emergencies.

As part of our inspection we examined arrangements in place to dispense medicines. We found medicines including controlled medicines were not always dispensed, stored or recorded correctly. We also found there was no process in place to check the storage temperature in the medicines fridge.

We spoke with eight members of staff and examined staff records. We found staff received some training and support relevant to their role. We found not all staff received the support they should such as individual appraisals or essential training.

During our inspection we looked at the system in place to review and learn from clinical incidents and near misses. We found there was evidence that learning from incidents, investigations took place and appropriate changes were implemented.

We examined the written records for three complaints. We found there was an effective complaints system in place to acknowledge, investigate and respond to complaints.