Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Vitty, Pfeiffer and Berni on 10 February 2016. Breaches of legal requirements were found. We found breaches of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the regulations). Warning Notices were issued in respect of Regulation 12 and Regulation 17 of the regulations. Requirement Notices were issued in respect of Regulations 18 and 19 of the regulations. The provider was required to make improvements and to submit an action plan detailing how they would make those improvements by 27 May 2016.

This focussed inspection on 15 June 2016 was to check that improvements required had been implemented and that the terms of each Warning Notice and the Requirment Notices had been met.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Drs Vitty, Pfeiffer and Berni on our website at www.cqc.org.uk.

The reference to the practice throughout this report refers to the practice now known as Drs Berni and Vitty, following the retirement of one of the GP partners, Dr Pfeiffer.

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

The provider had met the requirements to improve.

• Improvements to protect patients from harm had been implemented. We found systems and processes in place that promoted patient safety. For example, recruitment checks had been reviewed and checks required on all staff were now in place. Essential training for staff had been delivered and a comprehensive training matrix was in use which identified when staff were due for follow-up or refresher training.

• Significant events were now being routinely reported, recorded and investigated. The subject of significant events was now a standing agenda item for practice meetings and clinical meetings. All staff had received training in significant events and understood that reporting and recording these promoted safety within the practice.

• Improvements to the practice treatment and consulting rooms had been made to enable the practice to better comply with infection control standards. All rooms and the patient waiting and reception areas were fitted with sealed flooring; all consulting and treatment rooms were fitted with compliant sinks. Privacy curtains that were disposable were fitted round all examination couches. We saw that cleaning schedules were in place for all areas of the practice and the standard of cleaning was reviewed on a daily basis by the infection control lead or the appointed deputy.

• 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 well managed.
• 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.

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 Drs Vitty, Pfeiffer and Berni on 10 February 2016. Overall the practice is rated as Requires Improvement.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. Examples included; some recruitment checks had not been undertaken; not all essential training had been delivered; not all significant events were recorded, reported and investigated, improvements to infection control had not been implemented, health and safety information was out of date, management of clinical waste did not follow published guidance, safety checks on the building were incomplete and vaccines were not stored securely.

• The inspection team identified a number of significant medication errors in relation to patients’ medication. Review of patients care and medications had not been actioned as required.

• The way in which patient related correspondence was dealt with had not been sufficiently tested to ensure errors in changes to patients treatment, could be detected quickly.

• All equipment we saw had been calibrated and certified as being suitable for use.

• The practice had carried out work to effectively address levels of antibiotic prescribing that were higher than local and national averages.

• The practice clinicians responded quickly to patients who required a home visit and we saw that requests for these were recorded.

• Patients we spoke to told us they were happy with the service they received from the practice.

• Leadership required improvement. We saw that a new practice manager, who had been in place for a short period of time before our inspection, was working to introduce uniform procedures for all staff to follow.

• Clinicians met with multi-disciplinary team colleagues but this was only every 3 months, which is not considered sufficient to manage the care of patients in the community, for example those receiving palliative care.

• Clinicians at the practice were pro-active in seeking to improve patients’ health, working with community diabetes teams to identify patients at risk of diabetes, and in identifying patients at risk of frailty.

The areas where the provider must make improvements are:

• To ensure that all recruitment checks required are in place for all staff.

• To ensure all required staff training is scheduled and delivered.

• To record, report and investigate all significant events and ensure that all staff are aware of what constitutes a significant event.

• Ensure the Registered Manager is aware of their responsibilities in relation to the running and administration of the practice.

• Ensure robust systems are in place to confirm that all patients’ treatment, care and review of medications are actioned and recorded in patient records.

• Ensure multi-disciplinary team meetings are held with sufficient regularity to support the patients whose care is discussed.

• Review the current handling and processing system for all patient related correspondence to ensure that any directions from hospitals and other secondary care providers are implemented and recorded in patient records.

• Implement systems at the practice that keep staff,patients and other users of the practice premises, safe.

• Produce an electrical safety certificate for the building or organise testing to achieve this certificate.

• Ensure vaccines fridges in clinical rooms are secure and cannot be accessed by unauthorised persons.

In addition the provider should

• Engage with the CCG medicines management teams to review processes in place that keep patients safe in relation to call and recall of patients and review of medicines.

• Ensure staff have access to results of patient feedback, for example, from the month on month Family and Friends test results. Make these available to patients.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups the practice will be re-inspected within six months after the report is published. If, after re-inspection, the practice has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place the practice into special measures. Being placed into special measures represents a decision by CQC that a practice 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