Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 23 March 2016. Breaches of regulatory requirements were found during that inspection within the safe domain. The practice was rated as good overall and requires improvement in the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the regulatory responsibilities in relation to the following:

• Ensure that systems for the management and security of medicines are robust and safe:

We undertook this announced focused inspection on 19 January 2017 to check that the provider had followed their action plan and to confirm that they now met regulatory 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 Cowfold Medical Group on our website at www.cqc.org.uk. This report should be read in conjunction with the last report published in July 2016.

The practice continues to be rated as good overall and is now rated as good in the safe domain.

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

• We saw evidence to demonstrate that a safe system for managing and disposing of controlled medicines was in now place and was kept under regular review.

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 Cowfold Medical Group on 23 March 2016. 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.
• Risks to patients were assessed and generally well managed. However, medicines within the dispensary were not subject to regular audit and reconciliation and errors in recording of controlled drugs had not been identified prior to inspection. The practice had stocks of expired controlled drugs dating back a number of years that were stored safely but had not been destroyed in a timely way by an accountable officer.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. 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 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 and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure that controlled drugs are destroyed by an accountable officer in a timely way.

Ensure that regular audits and medicines reconciliation are carried out in the dispensary so there is a clearly documented audit trail of all medicines and issues are identified in a timely way.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this follow-up visit to Cowfold Medical Group to see if the provider had taken the necessary actions related to the areas of non-compliance from our inspection in December 2013.

During this follow-up inspection we looked at the practice infection control policies and cleaning arrangements. We found that the necessary actions had been taken in relation to these.

We also looked at recruitment processes during this inspection and saw that the provider had developed robust systems to ensure they only employed suitable staff.

We found, during this inspection that the provider had ensured that patients of the practice were made aware of how they could make a complaint should they need to.

We inspected the main surgery of Cowfold Medical Group on the day of our inspection. During our visit we spoke with two patients, four members of staff (which included the practice manager and one GP who was also the registered manager) and a visiting health professional. We also collected five responses to a questionnaire that we left in the waiting area for patients.

We saw staff treated patients with respect, for example, we saw that staff closed doors of the treatments rooms that provided privacy and dignity to patients. The patients that we spoke with told us that they felt respected by the staff at the practice. One patient told us “Yes, I’m treated with respect.”

We found that staff were aware of procedures around safeguarding vulnerable adults and children. We saw that the practice had relevant safeguarding policies and guidance and there was a lead contact for this at the practice.

We saw during our visit that the provider had not ensured that patients were not at risk of being treated in unsafe or unhygienic premises. We found some areas where we felt that systems needed to be improved.

When we looked at staff files, we found that the provider had not obtained all the relevant information that related to recruitment.

The practice had a complaints procedure however we found that this was not made easily available to people who used the service.