Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Guildowns Group Practice on 23 February 2016. The overall rating was requires improvement. During the inspection we found breaches of legal requirements and the provider was rated as requires improvement for providing safe and well-led services. Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the breaches.

We carried out a focused follow up inspection on 12 January 2017, this inspection was to verify if the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we had identified in our previous inspection on 23 February 2016. We found that they had completed their action plan and made significant improvements. Overall the practice was rated good. During the inspection we found a breach of legal requirements and the provider remained rated as requires improvement for providing safe services. Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring there is an efficient system across all four sites to securely track prescriptions for high risk medicines.

This report covers our findings in relation to the concerns regarding prescriptions for high risk medicines. The full comprehensive report on the 23 February 2016 and the focused follow up report on the 12 January 2017 inspection outcomes can be found by selecting the ‘all reports’ link for Guildowns Group Practice on our website at www.cqc.org.uk.

This inspection to the main practice and the three branch surgeries was an announced focused follow up inspection to confirm the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we had identified in our previous inspection on 12 January 2017. We found that they had completed their action plan and made significant improvements. Overall the practice is rated as good and the practice is now rated as good for providing safe services.

Our key findings at this inspection, 29 June 2017 were as follows:-

• The practice had implemented an efficient system in all four sites to securely track prescriptions for high risk medicines.
• All appropriate staff had been trained and understood the protocol for tracking prescriptions for high risk medicines.

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 Guildowns Group Practice on 23 February 2016. During this inspection we also inspected all three of the branch surgeries. The overall rating for the main practice and the branch surgeries was requires improvement. During the inspection we found breaches of legal requirements and the provider was rated as requires improvement under the safe and well led domain. Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that all complaints and safety incidents and their investigation were recorded.
• Ensuring that all complaints and safety incidents were investigated thoroughly. That patients affected received reasonable support and an apology and that learning was shared appropriately to support improvement.
• Ensuring recruitment arrangements included all necessary employment checks for all staff, including a Disclosure and Barring Service check or risk assessment.
• Ensuring that a system of annual staff appraisals was implemented and training completed was appropriate, including safeguarding.
• Ensuring that policies were up to date and specific to the practice.
• Ensuring action was taken to address concerns with fire safety and legionella as identified in the fire risk and legionella risk assessments.
• Ensuring that systems for storing medicines and vaccines safely were in place, in particular monitoring fridge temperatures.
• Ensuring systems were in place for the calibration of clinical equipment and portable electrical equipment was safe and used appropriately.
• Ensuring that the protocol for controlled medicine prescriptions was followed.
• Increase engagement with patients, for example by re-establishing a patient participation group to provide patient input to the practice.

The full comprehensive report on the February 2016 inspection outcome can be found by selecting the ‘all reports’ link for Guildowns Group Practice on our website at www.cqc.org.uk.

This inspection to the main practice and the three branch surgeries was an announced focused inspection carried out on 12 and 13 January 2017. This inspection was to verify if the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we had identified in our previous inspection on 23 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We saw that the practice had made significant improvements since our February 2016 inspection. Overall the practice is now rated as good, however the safe domain is still an area which requires improvement..

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting, recording and investigating significant events. Learning was shared with appropriate staff to support improvement.
• Risks to patients were assessed and well managed. Including fire safety and legionella and the monitoring of fridge temperatures where vaccines were stored.
• Clinical equipment was calibrated and electrical equipment had been PAT tested.
• Recruitment checks were carried out in accordance with practice policy. Risks assessments where in place to determine whether a Disclosure and Barring Service (DBS) check was required.
• Policies were up to date and specific to the practice.
• All staff had received an annual appraisal and staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and 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.The practice had re-established a patient participation group to provide patient input to the practice.
• 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.

We also found the practice had made improvements:-

• To patient telephone access to the practice and this was being monitored.
• To pro-actively identifying carers.

However, there was one area of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure there is an efficient system across all four sites to securely track prescriptions for high risk medicines.

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 Guildowns Group Practice on 23 February 2016. This reports refers to the location of Wodeland Avenue. Overall the location is rated as requires improvement.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, however the practice could not provide evidence of all appropriate training for example safeguarding training.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough. Patients did not always receive an apology.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example recruitment checks, staff training, medicines management, fire and legionella risk assessments.
• Information about services and how to complain was available and easy to understand. However, recording of reviews and investigations were not thorough enough. Patients did not always receive an apology.
• The practice had a number of policies and procedures to govern activity, but there was no system in place to ensure that these were up to date or appropriate for the location where they were in use.
• Not all staff had received an appraisal within the last 12 months, some staff had not had an appraisal for more than two years and the practice did not have a schedule in place for appraisals

The areas where the provider must make improvements are:

• Ensure that all complaints and safety incidents and their investigation are recorded.
• Ensure that all complaints and safety incidents are investigated thoroughly and ensure that patients affected receive reasonable support and an apology and that learning is shared appropriately to support improvement.
• Ensure recruitment arrangements include all necessary employment checks for all staff, including that a Disclosure and Barring Service check or risk assessment showing a check is not required is in place for all staff.
• Ensure that a system of annual staff appraisals is implemented and that training is completed as appropriate including safeguarding.
• Ensure that policies are up to date and specific to the practice.
• Take action to address identified concerns with fire safety and legionella as identified in the fire risk and legionella risk assessments.
• Ensure that blank prescription forms are stored securely.
• Ensure systems are in place to make sure clinical equipment is calibrated and portable electrical equipment is safe.
• Investigate ways to increase engagement with patients, for example re-establish a patient participation group to provide patient input to the practice.

In addition the provider should:

• Continue to monitor and review telephone access to the surgery.
• Continue to proactively identify carers.
• Review the use of patient specific directions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice