We carried out an announced comprehensive inspection at Brewood Surgery on 6 February 2019 as part of our inspection programme. We also visited the branch at Wheaton Aston as part of this inspection. We did not visit the branch at Coven as part of this inspection.

At the last inspection in April 2018 we rated the practice as requires improvement for providing safe services. This was because:

• There had been no health and safety risk assessment carried out for the premises.
• Non-clinical staff who acted as chaperones had not received a Disclosure and Barring Service (DBS) check and there was no risk assessment in place to demonstrate why such checks were not required.
• Staff were unaware of the practice’s continuity plans.
• We found a breach of regulation in relation to Good Governance: regulation 17 in particular:
• Systems to identify, mitigate and manage potential risks to patients and others in relation to the safe management of medicines was not effective.
• The security of medicines at both the main and branch surgeries was insufficient as there were no formal checks or records only the verbal assurances assurance of the dispenser competing the task.
• Processes did not ensure that all medicines were stored at the correct temperature at the Wheaton Aston branch surgery.
• Staff at the main surgery did not have written guidance or training on the dispensing of medicines.
• The recording of checks on emergency medicines held at the main surgery was not consistent.
• Dispensing records had not been kept for the correct period of time.
• There was no record of disposal for returned medicines at the Wheaton Aston branch surgery or record of disposal of some medicines in controlled drug registers.
• Prescription stationary and medicines were not managed securely at the Wheaton Aston branch surgery.

Our previous reports for this service can be found by selecting the ‘all reports’ link for Brewood Surgery on our website at www.cqc.org.uk.

At this inspection, we found that the provider had satisfactorily addressed these

areas. They had taken the following action in relation to the security issues:

• Both the main site and Wheaton Aston branch dispensaries had locked doors.
• The keys for these doors were securely locked away.
• The practice had active CCTV directed at these doors and all entry points.
• Emergency trolley cupboards on all sites now had tamper evident mechanisms in place

• All medicine fridges were locked on all sites.
• The practice had taken the following actions to imrove the Management of medicines
• All medication was now correctly stored and managed on all sites.
• Standard operating procedures (SOP)s were now in place for both the main and Wheaton Aston branch dispensary.
• The practice had identified responsible individuals and deputies for the dispensaries and procedures. They followed these up with checking procedures.
• The practice had made suitable improvements in the storage and ordering of all medicines.
• Date checking and stock rotation had been implemented at both the main site and Wheaton Aston branch surgery.

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 have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

Continue to monitor the documents within staff files.

Review the driver risk assessment periodically.

Review the analysis of significant events.

Formalise the clinical reviews for Advanced Nurse Practitioners.

Formalise checks on new procedures.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Brewood Surgery, on 26 June 2017. The overall rating for the practice was Good with Requires Improvement for providing safe services. We found two breaches of legal requirements and as a result we issued requirement notices in relation to:

Regulation 12 of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014 Safe Care and Treatment and 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 26 June 2017 inspection can be found by selecting the ‘all reports’ link for Brewood Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 5 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches that we identified in our previous inspection on 26 June 2017, and to review the action taken as a result of a recent significant event involving a dispensing error. 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:

• The practice had improved their staff recruitment procedures and ensured the required checks had been obtained prior to staff commencing employment. However, a risk assessment to determine if staff were eligible for a Disclosure and Barring Service check had not been carried out and documentary evidence of qualifications had not always been retained.

• The practice had reviewed and updated their business continuity plan and included staff telephone numbers in the event of an emergency.

• Staff had access to safeguarding information to include contact details for external agencies in the event of initiating a safeguarding referral.

• There was an open and transparent approach in place for reporting and recording significant events. A recent dispensing error had been appropriately reported to all relevant external agencies and an analysis of events undertaken and learning shared.

• A part-time practice pharmacist had been recruited to assist with the dispensing of medicines at the dispensing branch surgery.

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

• The provider had reviewed their systems for managing medicines and had made a number of improvements since the last inspection but these were not always effective or fully embedded in practice and did not always promote the safety of patients and others. For example, medicines and prescription stationary were not maintained securely at the branch surgery and there was no available guidance or staff training in dispensing patient’s medicines at the main surgery.

The areas where the provider must make improvements are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

For details, please refer to the requirement notices at the end of this report.

The provider should:

• Carry out a risk assessment to review to determine if staff are eligible for a Disclosure and Barring Service check based on their role, responsibilities and activities and to what level and obtain documentary evidence of staff qualifications.

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 Brewood 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 a system in place for reporting and recording significant events.

• The arrangements for identifying, recording and managing risks and implementing mitigating actions were in place but did not cover all areas to ensure that patients and staff were protected from the risk of harm at all times

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 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 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.

The areas where the provider must make improvement are:

• Ensure care and treatment is provided in a safe way to patients by improving the system to act upon medicines and equipment alerts issued by external agencies, for example from the Medicines and Healthcare products Regulatory Agency (MHRA).

• Ensure systems are put in place for the proper and safe management of medicines.

• Ensure recruitment checks as required by legislation are completed for all staff employed.

In addition the provider should:

• Ensure all staff know how to access information relating to safeguarding procedures and referral information.

• Develop a system which ensures blank prescription stationery are held securely and tracked through the surgery.

• Improve the accuracy of the recording within the controlled drugs register.

• Include emergency contact numbers for staff within the practice’s business continuity plan.

• Ensure standard operating procedures (SOPs) in place are in line with the practice wide policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice