Letter from the Chief Inspector of General Practice

On 17 February 2016 we carried out a comprehensive inspection at Dr Butler and Partners. The practice was rated as requires improvement overall. The practice was rated as requires improvement for safe and effective and good for caring, responsive and well led.

The practice were issued with a requirement notice for improvement for medicine management. As the practice pharmacy team were unable to demonstrate they had the competence, skills and experience to undertake their roles. Patient alerts had not been appropriately actioned and patient records reviewed to ensure safe prescribing practices and medicines reviews were not conducted in accordance with national guidance.

We also recommended the practice;

• maintained cleaning records to demonstrate when, where and how rooms had last been cleaned. Where improvements have been identified provide an audit trail to reflect they have been actioned.
• Recorded written patient consent for surgical procedures.
• Ensured staff receive training on infection and prevention control.

As a result of this inspection the practice sent us an action plan outlining the steps they had taken to improve.

We then carried out an announced follow up inspection at Dr Butler and Partners also referred to as Deal Tree Health Centre, on 3 June 2016 to check that the improvements had been made. We found that the practice had made the necessary improvements. Overall the practice is rated as good.

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

• The practice had introduced a medicine management lead GP who oversaw the actioning and review of medicine alerts to ensure safe prescribing.
• The medicine management lead GP had protected time allocated to be accessible to the dispensing team and undertake training and supervision.
• The dispensary staff had undertaken update training in accurate dispensing or the management of control drugs.
• The practice were members of the Dispensary Doctors Association and were surveying their patients to obtain their views and experience of their dispensary.
• The practice maintained cleaning records to demonstrate when, where and how rooms had last been cleaned. Where improvements had been identified they provided an audit trail to reflect they have been actioned.

• Written patient consent was obtained for procedures such as surgical procedures and muscle injection.
• Staff were scheduled to attend infection prevention control training in June. This was promoting awareness for hand hygiene, how to manage body spillage, safe disposal of clinical items.
• Staff reported a more transparent and supportive culture following the last inspection. Where their expertise was acknowledged and being utilised such as delivering inhouse training in infection prevention control and medicine management updates in chronic diseases.

However there was an area of practice where the provider should make improvements:

• Ensure the quality of the dispensary service through audit of the dispensing process and review of near misses and significant incidents.

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 Dr Butler and Partners also referred to as Deal Tree Health Centre on 17 February 2016. Overall the practice is rated as requires improvements.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. These were investigated thoroughly, learning identified and shared with the practice and external services, where appropriate.
• Medicine alerts were not sufficiently actioned and patient records reviewed to ensure safe prescribing.
• Staff employed in the pharmacy did not receive sufficient support and supervision in relation to their role.
• Data showed patient outcomes were similar to or above locality and nationally averages.
• Clinical audits had been carried out and used to inform and improve patient outcomes,
• Patients told us they were treated with compassion, dignity and respect. Staff always had time to listen and explain information to patients and their families and they were involved in decisions about their care and treatment.
• The practice provided a range of services to meet their patient needs including nurse lead chronic disease management clinics, baby clinics in partnership with the health visitor and Saturday morning surgery.
• Some patients reported difficulty at times obtaining convenient appointments. However, urgent and telephone appointments were usually available on the day they were requested.
• The practice promoted an open culture and valued and invested in their staff. However, they accepted improvements were required in their management of the dispensary.
• The practice had had an active patient participation group who were committed to improving patient services.

The areas where the provider must make improvements are:

• Ensure pharmacy staff receive sufficient support and training to demonstrate they have the competence, skills and experience to undertake their roles.
• Ensure medicine alerts are acted upon appropriately and that the system of reviewing repeat prescriptions is more robustly monitored.

In addition the provider should:

• Ensure the practice maintains cleaning records to demonstrate when, where and how rooms had last been cleaned. Where improvements have been identified provide an audit trail to reflect they have been actioned.
• Record written patient consent for surgical procedures.
• Ensure staff receive training on infection and prevention control.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice