Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Drs Mcelroy &Thompson Surgery on 19 October 2016. The overall rating for the practice was good but required improvement in providing safe services. The full comprehensive report on the 19 October 2016 inspection can be found by selecting the ‘all reports’ link for Drs Mcelroy &Thompson Surgery

on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good and good for providing safe services.

Our key findings were as follows:

• The practice had addressed the issues identified during the previous inspection.
• There were improvements in compliance with fire safety and health and safety. For example, action had been taken following a fixed electrical wiring safety risk assessment.

In addition, the practice had made the following improvements:

• There was a system to monitor the storage and use of blank prescription pads used for home visits.

• The practice had completed where practical actions identified in the external infection control audit from April 2016 and work was in progress for the scheduling and monitoring of the cleaning of the premises.
• The practice was aware that documents relating to staff recruitment were to be retained.
• There was a system to ensure all materials in the first aid kit were not kept beyond the expiry date.
• The practice policy and patient information leaflet had been updated and included the correct details of who the patient should complain to if they were dissatisfied with the practice’s response to their complaint.
• The practice was aware they needed to treat verbal complaints in the same way as written complaints but had not received any since our last inspection.
• The practice was exploring having a Patient Participation Group (PPG).

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 Mcelroy & Thompson Surgery on 19 October 2016. Overall the practice is rated as good but requires improvement in providing safe services.

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

• The practice was in a converted residential property and the provider was aware of the limitations of the premises such as access to some of the consultation rooms and treatment room upstairs.
• The practice identified patient access to appointments as a key priority. The GP national patient survey data indicated a high level of patient satisfaction with regards to accessing appointments and service provided compared to local and national averages.
• There were some systems in place to mitigate safety risks including analysing significant events and safeguarding. However, some risk assessments for the premises and equipment were not completed or incomplete in terms of remedial actions required.
• There was emergency medication and equipment available.
• The practice was aware of and had systems in place to ensure compliance with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).
• Patients’ needs were assessed and care was planned and delivered in line with current legislation.
• 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. The practice sought patient views about improvements that could be made to the service by using a suggestions box and monitoring NHS choices and looking at survey information; however the practice did not have a patient participation group (PPG).
• Staff worked well together as a team and all felt supported to carry out their roles.

The practice must:

Comply with all health and fire safety legislation and:-

• Complete any actions identified in the fixed electrical wiring report and fire risk assessment where practical to mitigate any risks. For example, carry out fire drills and display a map of the buildings at the entrance clearly showing where oxygen is stored.
• Carry out display screen equipment risk assessments for all staff.

• Carry out disabled access risk assessments.

The practice should:

• Monitor the storage and use of blank prescription pads used for home visits.
• Update the infection control policy and review national guidance for cleaning GP practices and complete where practical actions identified in the external infection control audit from April 2016.
• Update the health and safety policy and poster to incorporate the correct named leads.
• Retain all documents relating to staff recruitment.
• Update the practice policy and patient information leaflet to include the correct details of who the patient should complain to if they were dissatisfied with the practice’s response to their complaint.
• Treat verbal complaints in the same way as written complaints i.e. to record any verbal complaints and any actions taken as a result and monitor them for any trends.
• Reconsider having a Patient Participation Group (PPG). 
• Make sure all materials in the first aid kit are not kept beyond the expiry date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients were not interviewed during this inspection.

At our last inspection in November 2013 we identified improvements were needed relating to training and appraisals for all staff. Since this date the practice manager had introduced a system for staff appraisal. There were new systems in place for identifying staff training needs and ensuring courses attended were relevant to their roles.

We found there were improved systems in place for ensuring people who use the service received safe and quality care and support. We observed improvements to the incident reporting system and how this information was used to improve and monitor practice.

We reported at our last inspection that administrative staff had not been checked to ensure they were suitable to be in contact with children and vulnerable adults. We found that whilst improvements had been made to checking the professional registration of clinical staff, administration staff checks were still not in place.

We spoke with five patients during our inspection of the practice and their feedback about the service was positive. They said it was easy to secure an appointment and rarely had to wait for too long beyond their appointment time.

Patients told us they could make choices about their care and treatment because the GP explained their condition and the treatment options in a way they understood. A patient said, “I would not change from this practice. Sometimes it can be hard to understand and remember what doctors say but they explain things very well here.”

All the patients we spoke with said that they could book an appointment with their preferred GP most of the time. This was particularly important for a patient we spoke to who had complex health needs. The patient said, “If it was not for my GP, I would not have been seen by a specialist. The GP pushed for the referral.” Patients also confirmed that they were referred to other health care professionals by the GP in a timely way, and received an appointment quickly.

Medical records and other records containing confidential information were stored securely.

Overall, the systems to monitor the safety and quality of the service were not robust, with some monitoring processes under developed.

A programme of mandatory (required) training was not in place and not all staff working at the practice had received an annual appraisal.

We reviewed the information available to us about Drs Mcelroy & Thompson Surgery on 7 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.