Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hardwicke House on 3 October 2016. The practice was rated as good overall, and requires improvement for providing safe services as improvements were needed to ensure that medicines were managed appropriately. The full comprehensive report on the 3 October 2016 inspection can be found by selecting the ‘all reports’ link for Hardwicke House on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 April 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 3 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good overall and good for providing safe services.

Our key findings were as follows:

• Standard operating procedures which govern the dispensing of medicines were comprehensive and available at all dispensing sites. Effective standard operating procedures and log books for the recording of the destruction of medicines, including controlled drugs (medicines that require extra checks and special storage requirements because of their potential for misuse) had been produced and implemented.
• Systems and processes were in place to ensure that medicines, including vaccines, were stored within the recommended temperature range and medicines were checked for expiry dates. However the refrigerator thermometer was not being reset in line with guidelines in the dispensary at Hardwicke House. A standard operating procedure was submitted following the inspection to address this.
• The practice held appropriate emergency medicines which were checked regularly and were all in date.
• Patient group directives for the nursing staff had been signed and were up to date.
• A system was in place to ensure the practice management team had oversight of staff training and that staff were informed of updates and changes within the practice.

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 Hardwicke House on 3 October 2016.  Overall the practice is rated as good.

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

• The practice served a large population across five sites. Some staff worked across more than one site, generally, the practice managed communication well. Hardwicke House site was the administration centre for the practices.

• There was an open and transparent approach to safety and a system was in place for reporting and recording significant events. However the practice did not record errors that would identify trends and allow early interventions to encourage improvements.

• The practice used a range of assessments to manage the risks to patients.

• Practice 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. However, the management oversight of the training undertaken needed to be improved.

• 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. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it relatively easy to make an appointment with a named GP.

• 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.

  The provider was aware of and complied with the requirements of the duty of candour.

Action the provider MUST take to improve:

• Ensure that risk assessments are carried out to determine the need to hold

  appropriate emergency medicine for contraceptive procedures undertaken in the practices.

• Ensure that medicines are managed appropriately. This must include ensuring that appropriate action is taken and documented when the temperature of the medicine refrigerators is outside of the recommended range. This must also include the implementation of an effective system to check the expiry date of medicines. Also the production of an effective standard operating procedure and log books for the recording of the destruction of medicines, including controlled drugs.

Action the provider SHOULD take to improve:

• T

  here was scope for the practice management to improve t

  he standard operating procedures which govern dispensing processes. The procedure should be comprehensive and available at all dispensaries.

• There was scope for the practice management team to improve their governance systems and oversight, including the update and sign off of patient group directives for the nursing staff.

• There was scope for the practice management team to improve the oversight of staff training, through accurate and complete records.

• Improve governance arrangements by maintaining and disseminating minutes from practice meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We conducted this inspection to follow up on compliance actions following our last inspection on 06 November 2013 when we found concerns with regards to the emergency medication and equipment.

During our inspection on 06 November 2013 we found that people who used the surgery had unsupervised access to emergency medicines, needles and syringes.

During our inspection on 02 January 2014 we found that improvements had been made.

We spoke with three members of staff all of whom advised us of the new location of the emergency medicines and equipment. We saw that they were no longer stored in an unsupervised public area, but were kept in a room where people were unlikely to have access to them.

We visited the Hardwicke House surgery to undertake our inspection. We did not visit the other surgeries as part of our inspection.

We spoke with eleven people who used the surgery, all of whom advised us that they were involved in decisions regarding all aspects of their care and treatment. One person told us, “The doctor listens to me.” One clinician we spoke with said, “I support patients to make their decision by giving them information to make a decision.”

Care and treatment was described positively by the people we spoke with. One person said, “The care that I have here has been very good.” Another person said, “The receptionists are wonderful.”

We found shortfalls in that emergency medicines and equipment were kept in a publically accessible and unsupervised area of the surgery. We found that not all staff had training in cardiopulmonary resuscitation (CPR).

We spoke with three staff, all of whom had a good understanding of safeguarding. One clinician told us, “If a relative does not have the person’s best interests at heart, if it is affecting the person, then I would speak to the GP and maybe then social services.” We saw that some written guidance was in place for staff.

We looked at staff records. We saw that staff were supported but this was not always documented.

We saw that there was evidence that there was a process in place for investigating, responding to and learning from complaints and significant events.