Letter from the Chief Inspector of General Practice

This service is rated as Good overall. (Previous inspection 21 February 2017 to 23 February 2017 – Good)

The key questions that we looked at on this occasion were rated as:

Are services safe? – Good

We carried out an announced focused inspection at Frimley Primary Care Service on 7 November 2017 to follow up on breaches of regulations identified at the previous inspection of 21 February 2017 to 23 February 2017. We looked at aspects of the safe domain.

The full comprehensive report on the 21 February 2017 to 23 February 2017 inspection can be found by selecting the ‘all reports’ link for Frimley Primary Care Service on our website at www.cqc.org.uk.

At our inspection of 21 February 2017 to 23 February 2017, we found that:

• Medicines were not always provided to patients with an appropriate patient information leaflet.

• Processes in place for checking medicines, including those held at the base and in the out of hours vehicles were not sufficient to ensure that stock levels were appropriate.

• Contrary to guidelines some medicines supplies held in vehicles used for visiting patients had been split leaving only a few tablets inside the box and fewer than the number stated on the box.

• Lockable boxes held in each vehicle containing prescriptions for stock medicines and all medical records were only emptied every few days.

• Some boxes held in the out of hours vehicles for the safe storage and disposal of used sharps were being used longer than best practice guidelines and were incompletely labelled.

At this inspection we found that:

• All patients received an appropriate patient information leaflet when medicines were dispensed to them.

• A system of daily stock checks had been introduced that ensured that there were appropriate stocks of medicines stored at the base and available for the vehicles.

• Systems had been introduced to ensure that small quantities of medicines could be dispensed to patients and accurately recorded without splitting boxes containing full courses of medicines.

• The effectiveness of the new systems had been audited by the service.

• Lockable boxes in each vehicle containing prescriptions for stock medicines and all medical records were now emptied daily.

• Sharps boxes were being correctly used and labelled.

  Additionally we saw that:

• The service had reviewed the practice of clinicians providing their own personal equipment and was going to provide all the equipment themselves.

• Vehicle checklists had been revised and the levels of oxygen in the oxygen canisters held in the vehicles were checked daily.

• The complaints system had been revised, complaints were correctly identified and copies of communications were retained for an appropriate period of time.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Frimley Primary Care Service on 21, 22 and 23 February 2017. Overall the service is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
• Risks to patients were assessed and well managed with the exception of medicines management.
• Patients’ care needs were assessed and delivered in a timely way according to need. The service met the National Quality Requirements.
• 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.
• There was a system in place that enabled staff access to patient records and the out of hours staff provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
• The service managed patients’ care and treatment in a timely way.
• 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.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• There was a clear leadership structure and staff felt supported by management. The service 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.

We saw one area of outstanding service:

• The standard clinical system used by the majority of out of hours providers only categorises patients as urgent or routine, however the dispositions (recommended course of action) given by NHS 111 provide more options, for example, to be contacted within 30 minutes, one hour, two hours, six hours. The provider realised that patient prioritisation would be improved if the clinical system options matched the NHS 111 dispositions. The provider has developed in- house options within the clinical system so that the system shows patients in the same priorities as the dispositions that were assigned by NHS 111. We saw evidence that since this had been implemented there was month on month reduction in the time patients who had received each disposition were waiting for contact with the primary care centre.

The areas where the provider must make improvement are:

• Review the proper and safe management of medicines, including the quantity and variety of all medicines, including controlled medicines, that are held on site and in the vehicles and implement a system for recording the use of these medicines, and ensuring that sharps safes are labelled and used appropriately.

The areas where the provider should make improvements are:

• Undertake spot checks on clinician’s personal equipment to ensure it is calibrated and fit for purpose.

• Monitor the complaints system to ensure that all complaints are identified correctly and copies of all communications are retained for an appropriate period.

• Ensure vehicle checklists reflect the checks expected by the provider, including daily checks of the oxygen level in the cylinders.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice