Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Benfleet Surgery on 1 June 2016 to check on improvements made following the practice being placed into special measures in September 2015. The practice was taken out of special measures and was rated as good overall. However, the practice was found to be requires improvement for providing safe services. The full comprehensive reports on the September 2015 and the June 2016 inspections can be found by selecting the ‘all reports’ link for Benfleet Surgery on our website at www.cqc.org.uk.

This announced desk based review was carried on 22 September 2017 to confirm that the practice had made the improvements required that were identified in our previous inspection on 1 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is rated as good for providing safe services.

Our key findings were as follows:

• Since the previous inspection the practice had completed risk assessments in relation to the control of substances hazardous to health (COSHH). We were sent evidence of the risk assessments and safety sheets for the products in use at the practice. The practice had also completed risk assessments for other substances used at the practice. For example, liquid nitrogen and oxygen. A health and safety risk assessment had also been completed in October 2016 which was due for review in October 2017.

• Smart cards that were previously stored in the practice had since the previous inspection been removed and therefore there was no risk to patient confidentiality in relation to this.

• The governance framework was implemented and we were sent evidence of practice meetings held to show the topics discussed such as significant events, complaints and audit.

• The practice had completed second cycle audits and changes had been implemented to drive quality improvement. We saw that where improvements had been made, searches on the electronic patient record system had been planned to ensure this was ongoing.

• The practice had tried to promote a virtual patient participation group. However, there had been minimal response from the patients. The practice had focussed on their renovation project and when completed would focus on the PPG. Feedback from patients was collected on the amended complaints and comments leaflet in addition to the friends and family test and comments on NHS Choices which was monitored.

• Patients with complex needs were identified and we saw from the minutes of the practice meetings that these patients were discussed. Patients were added to the registers such as palliative and learning disabilities where appropriate. The practice had a low number of patients on the palliative care register. This was a true reflection of their patients that were appropriate for this care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 16 September 2015, we carried out a comprehensive announced inspection. We rated the practice as inadequate overall. The practice was rated as inadequate for providing safe, effective and well-led services, requires improvement for providing responsive services and good for providing caring services. As a result of the inadequate rating overall the practice was placed into special measure for six months.

At this time we identified several areas of concern including:

• Inadequate emergency medical equipment.
• Significant risks associated with health and safety, fire and infection control.
• Inadequate recruitment checks for staff.
• Inadequate governance arrangements for assessing and monitoring risks and the quality of service provision.
• Inadequate system for the identification, handling, recording, and responding to complaints.
• Inadequate system for ensuring staff received appropriate training.
• There was insufficient evidence of a programme of continuous audit to demonstrate improvement.
• Prescriptions were not all stored securely and there was no system in place to monitor their use.
• Translation services were not available should they be needed.
• Carers had not been actively identified in order to offer additional support.
• There had been limited attempts to gain patient feedback and there was no patient participation group.

An additional focused inspection was carried out on 11 November 2015. At this inspection some improvements were identified and a report was published.

Practices placed into special measures receive another comprehensive inspection within six months of the publication of the report so we carried out an announced comprehensive inspection at Benfleet Surgery on 1 June 2016 to check whether sufficient improvements had been made to take the practice out of special measures.

As a result of this inspection we have now rated the practice as requires improvement overall; requires improvement for providing safe services and good for proving effective, caring, responsive and well-led services.

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

• There was an effective system in place for reporting and recording significant events. All staff understood this system and significant events were routinely discussed at practice meetings and outcomes shared with all staff to ensure improvements were made.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There was a system in place to share new guidance. Patient safety alerts and medicine alerts were closely monitored; initial audits and monthly checks were made on patients affected by any new guidance, safety or medicine alerts to ensure their safety was protected.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about how to complain was available in several formats and was easy to understand. The practice was now proactively reviewing complaints at practice meetings and improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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 sought feedback from staff and patients where possible, work was underway to commence a virtual patient participation group (PPG) to engage further with patients and to seek feedback to drive improvement.
• Risks to patients were being assessed and managed, some risks associated with health and safety the control of substances hazardous to health still needed to be assessed.
• There was informal engagement with other health and social care organisations to deliver a multidisciplinary care package to patients with complex needs.
• We found that staff Smart cards were left in an unsecure location accessible by patients, thus putting patient confidentiality at risk.
• The practice management had begun a programme of renovation to the practice which was due to continue. The area completed at the time of our inspection displayed a high quality finish to improve the environment for staff and patients as well as to ensure effective infection control measures.
• The practice management displayed a clear leadership structure and had undertaken significant, documented succession planning for the future. Staff felt supported and motivated to continue the improvements already made.
• The provider was aware of and complied with the requirements of the duty of candour.

Areas where the provider must make improvement are:

• Ensure risk assessments related to health and safety and the control of substances hazardous to health are carried out and actions taken to address any risks identified.
• Ensure the security of staff Smart cards.

Areas where the provider should make improvement are:

• Continue to review and implement the new governance framework.
• Continue the newly implemented programme of continuous audit to drive improvement in patient outcomes.
• Implement the planned virtual patient participation group to encourage feedback from patients.
• Ensure all patients with complex needs are identified

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a short notice announced follow up inspection of Benfleet Surgery reviewing areas of concern on 11 November 2015. This was because of concerns highlighted during their initial inspection on 16 September 2015, where we found the practice was inadequate in respect of safe, effective and well led, good for caring and requires improvement for responsive.

As a consequence of concerns highlighted in the first inspection the practice was issued a notice under section 31 of the Health and Social Care Act 2008 placing conditions on their registration relating to conducting surgical activities and their management of infection prevention control. A report was also requested from the provider under regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in response to their governance activities.

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

• There was emergency medical equipment such as a defibrillator and oxygen accessible to staff. But staff had not received emergency first aid training and none was scheduled.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment. There was no risk assessment in place for administrative staff at risk of contracting blood borne disease from contact with body samples.
• Staff were reporting incidents, near misses and concerns, these were investigated, learning identified and communicated with staff.
• Staff had not received appropriate safeguarding training in children and vulnerable adults.
• The practice had reviewed their infection prevention control audit.
• There was insufficient assurance to demonstrate patients received effective care and treatment. For example, the practice had an absence of systems in place to assess the quality of clinical care being provided to their patients.
• We found the practice had addressed complaints, responding in a timely and appropriate manner. Lessons learnt from complaints had been shared with staff.
• The practice had a leadership structure, but formal governance arrangements were in their infancy.

The areas where the provider must make improvements are:

• Ensure recruitment processes include necessary employment checks for all staff.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure staff receive training, supervision and support to undertake their roles.

The areas where the provider should make improvements are:

• Schedule clinical audits.

On the basis of the ratings given to this service at the previous inspection conducted in September 2015, the provider was placed into special measures. This will be for a period of six months. We will inspect the provider again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

The practice has been served a notice placing conditions on their registration, which they must comply with. The conditions relate to the management and training of staff in relation to infection control and the suspension of surgical procedures.

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 Benfleet Surgery on 16 September 2015. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment, risks to patient safety such as insufficient infection control and fire safety had been identified but not actioned

Staff were reporting incidents, near misses and concerns, however these were not sufficiently investigated and there was no evidence of learning and communication with staff.

• There was insufficient assurance to demonstrate patients received effective care and treatment. For example, the practice had an absence of systems in place to assess the quality of clinical care being provided to their patients.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Appointments were available on the day and urgent requests responded to in a timely manner. Patients told us they never had to wait and were always able to speak to staff or a GP to resolve issues.
• The practice had a leadership structure, but formal governance arrangements were in their infancy.

The areas where the provider must make improvements are:

• Ensure there is appropriate emergency medical equipment in place.
• Ensure the premises are safe to provide care and treatment, addressing risks identified in fire assessments and infection prevention control assessments.
• Ensure recruitment processes include necessary employment checks for all staff.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure there is an accessible system for the identification, recording, handling and responding to complaints.
• Ensure staff receive training, supervision and support to undertake their roles.
• Ensure appropriate policies and guidance are in place to support staff to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

The areas where the provider should make improvements are:

• Review complaints and significant incidents for trends and themes
• To implement recommendations from the practice audits.
• Record serial numbers of prescription pads and record who they are issued to.
• Ensure patients have access to translation services, where required.
• Capture and consider the experiences of patients to inform service improvements
• Ensure arrangements are in place to record accidents
• Ensure carers are identified and their needs considered and responded to.

On the basis of the ratings given to this service at this

inspection, I am placing the provider into special

measures. This will be for a period of six months. We will

inspect the provider again in six months to consider

whether sufficient improvements have been made. If we

find that the provider is still providing inadequate care we

will take steps to cancel its registration with CQC.

I have

also served a notice on the provider placing conditions on their registration, which they must comply with.

The conditions relate to the management and training of staff in relation to infection control and the suspension of surgical procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice