Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Newark Road Surgery on 6 January 2016. Overall the practice is rated as requires improvement.

Specifically, we found the practice was rated as requires improvement for being safe, effective and well led and rated as good for providing caring and responsive services. It was rated requires improvement for providing services for, older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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. The system in place for incidents, near misses and concerns was not robust. Learning from incidents was not disseminated to all staff.
• The systems in place for safeguarding children and vulnerable adults were not robust.
• Risks to patients were assessed and managed, with the exception of those relating to fire, legionella and infection control.
• Data showed patient outcomes were low for the locality in some of the long term conditions.

• 92% of patients who responded to the January 2016 national patient survey described the overall experience of the surgery as good compared with a CCG average of 87% and a national average of 85%.

• 75% of patients who responded to the January 2016 national patient survey described their experience of making an appointment as good compared with a CCG average of 76% and a national average of 73%.

• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
• The practice provided GP led triage so urgent appointments were available on the day.

• The practice had a number of policies and procedures to govern activity. However there was no guidance for staff on legionella, cold chain, checking of emergency equipment and medicines.

• The practice had not proactively sought feedback from patients but had an active patient participation group.

The areas where the provider must make improvements are:

• Introduce robust processes for recording, investigating, acting upon and monitoring of significant events, incidents and near misses.

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

• Review significant events and complaints in order to detect themes. Ensure learning from significant events and complaints is shared with staff.

• Take action to address identified concerns with infection prevention and control practice.

• Ensure fire drills and fire alarm testing are carried out regularly

• Ensure all staff receive annual appraisals.

• Ensure the nurse prescriber has clinical supervision

• Put a robust system in place for the recall of patients with long term conditions and undertake annual reviews.

• Carry out reviews for patients with a learning disability.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice and which identify the responsible person. For example, legionella, cold chain, checking of emergency equipment and medicines and recruitment and retention of staff.

The areas where the provider should make improvement are:

• Ensure actions from risk assessments are documented and date completed recorded.

• Within the Business Continuity Plan ensure mitigating risks and actions are included.

• Have in place a schedule of minuted meetings

• Ensure recruitment arrangements include all necessary employment checks and references for all staff.

• Ensure all staff have received safeguarding update training.

• Embed a system for the identification of carers

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 the practice on 6 January 2016. A breach of legal requirements was found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach of Regulation 12, 13, 17 and 18.

We undertook a focussed inspection on 26 July 2016 and 2nd August 2016 to check that they had followed their action plan and to confirm they now met their legal requirements. This report only covers our findings in relation to those requirements.

You can read the last comprehensive inspection report from January 2016 by selecting the ‘all reports’ link for Newark Road Surgery on our website at

www.cqc.co.uk

• We found that an improved significant event system had been put in place. The policy and reporting form had been updated. The practice had had eight significant events since the last inspection and we looked at them all. We found the updated system still required some improvement to ensure that the investigations were detailed and actions were identified and implemented.

• The practice now had a system in place to ensure that patients were safeguarded from abuse and improper treatment

• We found that in most cases learning from significant events and complaints was shared with staff but themes and trends still needed to be identified and an action plan put in place where appropriate.

• Risks to patients were now assessed and most were well managed.

• Action had been taken to address identified concerns with infection prevention and control practice.

• A fire drill had taken place and fire alarm testing was carried out regularly

• The practice had embedded a process to ensure emergency equipment and medicines were checked as per the practice protocol.

• Staff had received an annual appraisal.

• We found the nurse prescriber had received clinical supervision

• There was system in place for the recall of patients with long term conditions and undertake annual reviews.

• The practice had a new system for the identification of carers.

• The practice had commenced a more formalised process for the recording of minutes of meetings but the clinical meeting minutes still required more detail.

• Staff had appropriate policies and guidance in place to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice and which identify the responsible person. For example, legionella, cold chain, checking of emergency equipment and medicines.

The areas where the provider should make improvements are:

• Continue to embed the updated system for significant events and identification of carers.

• Identify themes and trends from significant events and complaints and take action where appropriate.

• Complete the work required to ensure staff and patients are safe. For example, in regard to fire safety.

• Ensure the reviews for patients with a learning disability take place.

• Ensure all staff files have the appropriate recruitment documents and files are in order as per the practice policy.

• Complete the appraisal process ensuring the

  notes of the discussions that had taken place are typed and added to the staff file.

• Complete the process for reorganising all staff files.

• Include safety alerts for discussion at meetings and ensure minutes are detailed.

• Continue to assess and monitor the quality and safety of the service provision by completing a full patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice