Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Fronks Road Surgery on 03 November 2015. The practice was rated as inadequate overall. Specifically they were rated as good for caring services, and inadequate for safe, effective, responsive, and well-led services. As a result, we took enforcement action against the provider and issued them with warning notices to comply by 11 March 2016. These warning notices required the provider to make improvements. As the practice was rated inadequate, overall they were placed in special measures for a period of six months.

The practice told us at the beginning of March 2016 they had completed all the work in their action plan, and addressed all the failings set out in the warning notices. We agreed to bring forward the comprehensive follow-up inspection of the practice. This inspection took place on 10 May 2016, and the practice was rated as requires improvement overall. Specifically they were rated good for safe services, and requires improvement for effective, caring, responsive, and well-led services.

We carried out this announced follow-up comprehensive inspection at Fronks Road Surgery on 31 October 2017. Overall, the practice is rated as good.

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

• The practice had made improvements across all areas identified at our last inspection.
• Staff members knew how to raise concerns, and report safety incidents.
• Safety information was appropriately recorded and learning was identified and shared with all staff during practice meetings.
• The infection control policy met national guidance.
• Risks to patients and staff were assessed, documented and acted on appropriately.
• The practice had arrangements and processes to keep adults and children safe and safeguarded from abuse.
• Staff assessed patient care in line with current evidence based guidance.
• The practice had an effective system to act on and review patient safety and Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Staff showed they had the skills, knowledge, and experience to deliver responsive, effective care and treatment.
• There were seven clinical audits undertaken and we saw two completed audit cycles enabling improvements to be measured.
• The system to monitor patients repeat prescriptions was effective.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available in leaflet form in the waiting room, in an easy to understand format.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest manner.
• The facilities and equipment was appropriate to treat and meet patient’s needs.
• Staff felt supported by the practice manager and clinicians this included their access and support for training. However, succession planning, or to federate and work collaboratively with other practices was not seen.

The areas where the provider should make improvement are:

• Continue to monitor patient satisfaction to identify areas for improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Fronks Road Surgery on 03 November 2015. The practice was rated as inadequate overall. Specifically they were rated as good for caring services, and inadequate for safe, effective, responsive, and well-led services.

In particular, on 03 November 2015, we found the following areas of concern;

• Out of date policies and procedures in relation to published guidance and legislation to provide guidance and support to staff members.
• A lack of guidance and support for staff carrying out infection prevention and control procedures, including cleaning and environmental checks and audit.
• The management of patient safety and medicine alerts and the storage of medicines, including controlled drugs.
• A lack of monitoring and assessing the services provided at the practice including acting on patient feedback.
• Staff members were not receiving regular supervision and appraisal for their roles, including those responsible for dispensing medicines.
• Staff acting as chaperones had not received a disclosure and barring service check or a risk assessment as to why one was not necessary.

As a result of our findings at this inspection we took enforcement action against the provider and issued them with warning notices with a requirement to comply with them by 11 March 2016. These warning notices required the provider to make improvements in relation to the safety of patients, the governance systems in place at the practice and their supervision and appraisal staff.

As the practice was rated as inadequate overall they were also placed in special measures for a period of six months.

Following the inspection on 03 November 2015 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations and the warning notices that we issued.

The report of the November inspection was published in March 2016. The practice contacted us at the beginning of March 2016 to say that they had completed all the work in their action plan, and addressed all the failings set out in the warning notices. As a result, we agreed to bring forward our comprehensive inspection of the service. This inspection took place on 10 May 2016.

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

• Staff members knew how to raise concerns, and report safety incidents. The policy showed the practice complied with the requirements of the duty of candour. Safety information was recorded and any issues identified were shared with staff members within practice meetings.
• There was a named GP responsible for the dispensary, and all staff involved had now received appropriate training. Controlled drugs were stored in line with guidance.
• The practice had reviewed most of their policies and procedures and was in the process of bringing them all up to date.
• Most risks to patients were assessed and documented with the exception of monitoring and reviewing medicines, including those that were high risk.
• The practice had an effective system for the management of patient safety and medicines alerts.
• Patients received regular monitoring of their prescribed medicines but this was not always being consistently recorded in patient records.
• Patient care was provided to reflect best practice using recommended current clinical guidance.
• Staff carrying out chaperone duties had been trained for the role and had received a disclosure and barring service check.
• Data from the Quality and Outcomes Framework for 2014/15 was generally below local and national averages.
• Patient comments were positive about the practice during the inspection; we were told they were treated with consideration, dignity and respect. The practice had recently set-up and started to work with their patient participation group to seek and act on patient feedback.
• Information regarding how to complain was available on the reception notice board and in an easy to read format.
• The leadership structure at the practice was understood by all the staff members we spoke with. They told us they were supported in their working roles by the practice management. A staff supervision and appraisal process was now in place.
• There was now an improved quality improvement system in place including the use of clinical audits.
• Meeting arrangements for regular multidisciplinary team meetings for patients with palliative care or complex needs were in the process of being arranged on a regular basis.
• The practice reviewed patients discharged after hospital treatment and attending accident and emergency (A&E); to update treatment plans and record actions taken to reduce the risk of re-admission.
• Infection control procedures had improved but quality control checking processes taking place were not being recorded. An infection control audit had not been carried out in line with the practice policy.
• The practice had not developed consistent treatment plans for patients with complex needs and/or those seen by multiple healthcare agencies.
• The system of governance had improved but still required strengthening.

The areas where the provider must make improvement are:

• Act on patient feedback to improve patient satisfaction as highlighted in the national GP patient survey published in July 2016.
• Continue to develop the practice system for policies and procedures, to effectively keep them updated, reviewed, and compliant with the requirements. This must include ensuring patient records are updated and maintained.

The areas where the provider should make improvement are:

• Document and record the quality control checks performed by the infection control lead and carry out infection control audits in line with practice policy and guidance.
• Ensure the electronic patient record is used to record all patient care and treatment in the same way by all GPs.

I am taking this service out of special measures. This recognises the significant improvements the provider has made to the quality of care provided by this practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Fronks Road Surgery on 03 November 2015. The practice was rated as inadequate overall. Specifically they were rated as good for caring services, and inadequate for safe, effective, responsive, and well-led services. As a result, we took enforcement action against the provider and issued them with warning notices to comply by 11 March 2016. These warning notices required the provider to make improvements. As the practice was rated inadequate, overall they were placed in special measures for a period of six months.

The practice told us at the beginning of March 2016 they had completed all the work in their action plan, and addressed all the failings set out in the warning notices. We agreed to bring forward the comprehensive follow-up inspection of the practice. This inspection took place on 10 May 2016, and the practice was rated as requires improvement overall. Specifically they were rated good for safe services, and requires improvement for effective, caring, responsive, and well-led services.

We carried out this announced follow-up comprehensive inspection at Fronks Road Surgery on 31 October 2017. Overall, the practice is rated as good.

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

• The practice had made improvements across all areas identified at our last inspection.
• Staff members knew how to raise concerns, and report safety incidents.
• Safety information was appropriately recorded and learning was identified and shared with all staff during practice meetings.
• The infection control policy met national guidance.
• Risks to patients and staff were assessed, documented and acted on appropriately.
• The practice had arrangements and processes to keep adults and children safe and safeguarded from abuse.
• Staff assessed patient care in line with current evidence based guidance.
• The practice had an effective system to act on and review patient safety and Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Staff showed they had the skills, knowledge, and experience to deliver responsive, effective care and treatment.
• There were seven clinical audits undertaken and we saw two completed audit cycles enabling improvements to be measured.
• The system to monitor patients repeat prescriptions was effective.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available in leaflet form in the waiting room, in an easy to understand format.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest manner.
• The facilities and equipment was appropriate to treat and meet patient’s needs.
• Staff felt supported by the practice manager and clinicians this included their access and support for training. However, succession planning, or to federate and work collaboratively with other practices was not seen.

The areas where the provider should make improvement are:

• Continue to monitor patient satisfaction to identify areas for improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice