We carried out an announced comprehensive inspection at Collington Surgery on 22 March 2019 as part of our inspection programme.

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:

• Systems and processes were in place in the dispensary to ensure that medicines were managed appropriately.
• 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.
• Staff felt supported by leaders within the practice.
• There were systems within the practice to assess, manage and mitigate risks. However, the practice had not acted on water temperatures in one part of the practice that were below the recommended range within the legionella risk assessment.
• The practice learned and made improvements when things went wrong, although action to address safety alerts was not recorded.
• An audit of high-risk medicines showed some areas where patient monitoring was not in line with guidance. While the records we viewed showed that monitoring had taken place since the audit, further action to ensure regular monitoring took place was not evident.

The areas where the provider must make improvements are:

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

In addition, the provider should:

• Continue to work to develop the patient participation group.
• Review temperature monitoring of water outlets and action taken to address this.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 17 November 2015. Breaches of legal requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• To ensure child safeguarding training was completed for all reception and administration staff to the appropriate level.

• To ensure that risk assessments for all staff were carried out to assess whether they required Disclosure and Barring Service (DBS) checks. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). Staff needing DBS checks should have received the appropriate checks to the right level for their role.

• To ensure recruitment arrangements included all necessary employment checks for all staff and that these were recorded in the staff files.

• To ensure risk assessment and monitoring processes effectively identified, assessed and managed risks relating to the health, safety and welfare of patients and staff. Specifically the practice must carry out a Legionella risk assessment.

• To introduce a robust system to ensure that emergency equipment was checked regularly and the findings recorded.

We undertook this focused inspection on 15 March 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Collington Surgery on our website at www.cqc.org.uk

This report should be read in conjunction with the last report from November 2015. Our key findings across the areas we inspected were as follows:-

• Child safeguarding training had been completed for all reception and administration staff to the appropriate level.

• Risk assessments were carried out for all reception staff to assess whether they required DBS checks. All reception staff had subsequently received DBS checks to the appropriate level for their role.

• All required recruitment checks were carried out and recorded in the staff files.

• Risk assessment and monitoring processes effectively identified, assessed and managed risks relating to the health, safety and welfare of patients and staff. Specifically the practice had carried out a Legionella risk assessment and acted upon its recommendations.

• We saw that the oxygen cylinder was within its expiry date and full and that there was a contract in place to ensure that it was replaced when required. The defibrillator pads were also within their expiry date.

• A robust system had been introduced to ensure that emergency equipment was checked regularly and the findings recorded.

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 17 November 2015 on Collington Surgery. 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.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said 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 easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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 and complied with the requirements of the Duty of Candour.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a strong focus on continuous learning and improvement at all levels within the practice. The practice was a training practice for GP registrars and was also involved in the training of medical and nursing undergraduates.
• The oxygen cylinder was out of date and contained only 140 litres of oxygen and therefore may not be fit for purpose in an emergency.
• Reception and administration staff had not been risk assessed as to whether their roles required them to be DBS checked.
• Not all recruitment files contained evidence that all the necessary employment checks for staff had been carried out.
• Risks to patients and staff were not always assessed and well managed
• Staff had generally received training appropriate to their roles and any further training needs had been identified and planned. However, some reception and administrative staff had not received training in the safeguarding of children.

The areas where the provider must make improvement are:

• Ensure the introduction of a robust system of regular recorded emergency equipment checks.

• Ensure child safeguarding training is completed for all reception and administration staff to the appropriate level in terms of role and risk to patients

• Ensure recruitment arrangements include all necessary employment checks for all staff and that these are recorded in the staff files.

• Ensure that risk assessments for all staff are carried out to assess whether they require DBS checks. Staff needing DBS checks should receive the appropriate checks to the right level.

• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff. Specifically the practice must carry out a Legionella risk assessment.

In addition the provider should:

• Ensure that if mercury containing instruments are to be retained on the premises then a suitable mercury spillage kit should be available.

• Review exception reporting rates to assess ways of reducing exception numbers.

• Complete the second cycle of the audit on the use of bone-sparing agents.

• Ensure that all induction training is recorded, signed and stored in staff files.

• Ensure that the practice  accesses and analyses patient feedback via the virtual Patient Participation Group (PPG)

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice