• The practice had  reviewed the process for monitoring the temperature of refrigerators used to store medicines.
• The practice had taken steps to ensure patient confidentiality at the reception area.
• The practice had responded to concerns over appointment availability and had introduced a ‘sit and wait’ system to meet the needs of some patients.

The areas where the provider should make improvements are:

• Monitor and review the appointment system and availability.
• Review and monitor patient satisfaction with the service provided.
• Review the process for monitoring and regulating the temperature of the dispensary at Ingoldmells.

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 Beacon Medical Practice on 8 November 2017. The practice is rated as good for caring and requires improvement for safe effective, responsive and well-led. Overall the practice is rated as requires improvement.

At the last inspection on 15 July 2015 it was rated as good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) – Requires improvement.

They are rated as requires improvement because the ratings for safe, responsive, effective and well-led applied to everyone using the practice including all population groups.

At this inspection we found:

• The practice had good facilities and was well equipped to treat patients and meet their needs. However the branch surgery at Chapel St Leonards was in need of replacement or substantial extension and refurbishment.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice identified learning but the actions from the learning was not always implemented.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines, although leaders had not taken positive action to ensure that an un-commissioned service being undertaken at the practice was being conducted with appropriate clinical oversight or ceased.

• The practice had an effective process for managing risk such as those posed by healthcare associated infections, fire and waste management.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients we spoke with said they found it difficult to get appointments and reported that they were not able to access care when they needed it.

• Feedback from patients about their interactions with nurses was positive but patients were less satisfied with their dealings with GPs.

• There was no evidence of clinical audit being undertaken to help improve patient outcomes.

• The processes for manging medicines posed a risk of people not always being kept safe.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example in their leading in anti-coagulation services for the area.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure that there is a protocol in place for obstetric ultra-sound scanning and ensure that there is clinical oversight and audit of the service provided.

• The practice must ensure that learning identified as a result of significant events investigations is cascaded to all GPs and staff and that the actions are implemented.

• Prescribers must consider and satisfy themselves ofthe appropriateness of issuing repeat prescriptions.

• Blank prescription forms should be securely stored when not in use to prevent unauthorised access to them.

• Ensure that dispensary standard operating procedure documents are correctly signed.

• Patient group directives should be reviewed and updated to reflect that individual nurses are specifically authorised.

• Complete clinical audits to drive quality improvement.

The areas where the provider should make improvements are:

• Undertake an audit on non-clinical prescribing practice.

• Remind staff that medicines should be retained in their original packaging.

• Should take steps to remind reception staff of the need for patient confidentiality.

• Review the procedures for monitoring the temperatures of fridges used to store medicines.

• Should continue to monitor patient satisfaction with regard to appointment availability and take steps to improve access to services.

• Review the arrangements in place for obstetric ultra sound scanning to ensure the procedures do not impact on clinical time to deliver the core commissioned services.

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 focused inspection at Beacon Medical Practice on 15 July 2015. Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe, responsive and well-led services.

We had previously inspected this practice on 6 October 2014 when we found that the practice required improvement in providing safe, responsive and well led services.

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

• The practice had implemented a system to ensure that incoming mail was dealt with in an appropriate manner to help ensure patients were safe.

• There was evidence that learning from significant events and complaints was communicated to staff to support improvement.

• The practice had reviewed the infection prevention and control policy which now included the need for repair or replacement of equipment to support effective infection control.

• There was a clear management structure with GPs in designated lead roles.

• A programme of continuous cycle audit was used to monitor quality and to make improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected this service on 6 October 2014 as part of our new comprehensive inspection programme.

The overall rating for this practice is requiring improvement. We found the practice to be good in the effective and caring domains and required improvement in the safe, responsive and well-led domains. We found the practice required improvement in the care they provided to the population groups of older people, people with long term conditions, working age people, people experiencing poor mental health  and  people in vulnerable circumstances.

.Our key findings were as follows:

• The practice had started to put systems in place to provide a better service for older people, those with long term conditions and those with learning disabilities. These systems had not yet had the time to be embedded in order to judge their impact.

• The practice had recognised that there was a lack of patient satisfaction with access to appointments particularly during the peak holiday season due to an increase in the number of temporary residents.  There was evidence of on-going monitoring and initiatives to respond to the situation to increase appointment availability although it remained a problem at peak times of the holiday season due to an influx of temporary residents. The practice had been working with the Clinical Commissioning Group and Patient Participation Group (PPG) to address this issue.

• The practice had systems, processes and policies in place to manage and monitor risks to patients, staff and visitors to the practice.

• Evidence we reviewed demonstrated that most patients were satisfied with how they were treated and that this was with compassion, dignity and respect. It also demonstrated that the GPs were good at listening to patients and gave them enough time.

• The practice had gone through a period of change in respect of staffing which had an impact on staff  morale. It was clear from discussions with staff that morale had improved and  they now felt valued and well supported.

There were areas of practice where Beacon Medical Practice needed to make improvements.

We have asked the practice to take action on three issues where we found that improvements were needed. The provider was in breach of the regulation related to assessing and monitoring the quality of service provision.

Importantly, the provider must:

• Review the infection control action plan and make it more robust with respect to timescales. It should also reflect the need for repair or replacement of equipment to ensure infection prevention and control. Staff should be made aware of relevant outcomes of the infection control audit.

• Have a system in place to audit the quality of data added to medical records and assess the appropriateness of a non clinical staff member having responsibility for assessing some incoming clinical information.

• Have a system in place to ensure that learning from incidents and complaints is identified and disseminated to staff appropriately and widely enough.

Additionally the provider should:

• Ensure that all staff are aware of who holds  lead roles within the practice and the responsibilities of those roles.
• Review the length of appointment slots to ensure they meet the needs of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice