Letter from the Chief Inspector of General Practice

We carried out an announced focussed follow up inspection on 6 October 2016 to follow up on concerns we found at Dr DJ Corlett & Partners at Beechfield Medical Centre, Spalding on 24 November 2015. The inspection in November 2015 was to ensure that improvement had been made following our inspection in February 2015 when breaches of regulations had been identified. The inspection in November 2015 found breaches of regulation and rated the practice as requires improvement overall, specifically in safe and well-led services.

At the inspection on 6 October 2016 we found that overall the practice had implemented changes and that the service was meeting the requirements of the regulations. The ratings for the practice have been updated to reflect our findings following the improvements made since our last inspection in December 2015; the practice is now rated as good overall.

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

• The system for reporting, investigating and learning from significant events had been strengthened.

• Systems policies and procedures were in place and accessible to all staff.

• Learning from complaints was documented and shared with all staff at practice meetings. An annual review had identified themes and trends.

• Staff had appropriate policies and guidance to carry out their roles in a safe and effective manner such as nurse protocols.

• There was a system in place to ensure that patients are safeguarded from abuse and improper treatment.

• Audits had been completed in relation to the quality of their dispensing service.

• Patient Group Directions were in place and had been appropriately completed.

• Infection control audits had taken place and action plans showed actions completed.

• There was a risk assessment in place relating to the control of substances hazardous to health (COSHH).

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 of Dr DJ Corlett & Partners at Beechfield Medical Centre, Spalding on 24 November 2015. The purpose of this inspection was to ensure that improvement had been made following our inspection in February 2015 when breaches of regulations had been identified.

Following the most recent inspection we found that overall the practice was still rated as requires improvement but significant improvements had been made and specifically, the rating for providing a safe service had improved from inadequate to requires improvement.

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

• The system for reporting, investigating and learning from significant events had improved but was not robust and further improvments were required.

• Some of the systems and processes in place were not robust. For example, safeguarding, infection control, dispensary and the triage system.

• Data showed patient outcomes were average or above for the locality. There was a programme in place for ongoing clinical audits.
• Patients said they were treated with compassion, dignity and respect. They were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Information about services and how to complain was available. However learning from complaints was limited.

• Urgent appointments were available on the day they were requested through the triage system.

• There was an improved and clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients.

The areas where the provider must make improvements are:

• Ensure robust processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and complaints are in place.

• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice, such as nurse protocols.

• Ensure there is a robust system in place to ensure that patients are safeguarded from abuse and improper treatment.

• Ensure the system for triage is robust including competency checks.

• To conduct audits of the quality of their dispensing service.

In addition the provider should:

• Ensure Patient Group Directions are completed appropriately.

• Ensure issues identified in the most recent infection control audit are actioned.

• Ensure there is an appropriate risk assessment in place relating to the COSHH).

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 of Dr DJ Corlett & Partners at Beechfield Medical Centre, Spalding on 12 February 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice inadequate for providing safe services and requiring improvement for being effective and well led. It also required improvement for providing services for all the population groups. It was good for providing a caring and responsive service.

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

• There was not a clear system for reporting incidents, near misses or concerns, therefore evidence of learning and communication to staff was limited.
• Data showed patient outcomes were average or above for the locality. Although some audits had been started, we saw no evidence that audit cycles had been completed and therefore were not driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect. They were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Complaints had not always been investigated fully and therefore learning from them was limited.
• Urgent appointments were available on the day they were requested through the triage system.
• The majority of practice policies had been withdrawn for review as they were either out of date or inaccurate.
• The practice had not proactively sought feedback from staff or patients.

The areas where the provider must make improvements are:

• Ensure audits of practice are undertaken, including completed clinical audit cycles.
• Ensure there are mechanisms in place to seek feedback from staff and patients and this feedback is responded to.
• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• 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 a robust system to manage and learn from significant events, near misses and complaints.

Ensure staff are appropriately supported by means of training and appraisal.

• Have a system in place for monitoring and training of all staff.

In addition the provider should:

• Have a system in place to ensure that all staff receive and act accordingly on NPSA/MHRA alerts.
• Have a system in place to track prescription pads in the practice.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice