Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Street Practice on 11 January 2016. Although, the overall rating for the practice was good, we found the safe domain required improvements . The full comprehensive report on January 2016 inspection can be found by selecting the ‘all reports’ link for High Street Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 January 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 11 January 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good in the safe domain and good overall.

Our key findings were as follows:

At the previous inspection

, we found the practice did not have a named infection control lead, or a schedule for the cleaning of carpets and curtains. In addition, some of the sterile single use equipment had expired beyond the date the manufacturer recommended it to be used by. At this inspection, we found the practice had a named lead for infection control. The practice manager had completed a comprehensive infection prevention and control risk assessment. Where the risk assessment had identified any risks, staff had implemented an action plan to mitigate these. For example, the staff had replaced the carpets in clinical areas with vinyl flooring, replaced the curtains in clinical areas with disposable curtains, and set up a system to check the expiry dates of single use equipment. We saw that staff had labelled the waste boxes for sharp instruments correctly.

At the previous inspection, we found the staff had not effectively monitored the refrigerators used for the safe storage of vaccines. At this inspection, we found the practice had investigated and learned from our findings at the previous inspection and had implemented a system to make sure staff monitored the fridge temperatures correctly. 

At the previous inspection, we found medication was passed the date for safe use and there wwere unlocked medications in the treatment room. At this inspection, we found the practice had purchased locked cupboards for the storage of medicines and that staff had implemented a new computer database to log all the practice medications on. This identified when stock was low and if the medication had passed the date of safe use.

At the previous inspection we found the practice had inadequate arrangements in place to respond to emergencies and major incidents. At this inspection we found the practice had implemented a system to ensure emergency medication was checked and safe to use. The practice had purchased a defibrillator and instructed staff on how to use it. Staff checked the oxygen and defibrillator weekly. However, the resuscitation airways did not have a expiry date. The nurse agreed to check these were safe to use.

At the previous inspection we found that staff had not secured the blind cords in accessible areas with a cleat; this could pose a risk to children's safety. The practice manager explained that they had removed the blinds in the reception area and staff were always present in the consulting and treatment rooms. Following the inspection the practice manager provided us with a risk assessment to show how the risks were managed.

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 High Street Practice on 11 January 2016. Overall the practice is rated as good.

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

• Risks to patients were assessed and well managed with the exception of checking expiry dates of single use items, medicines. There was also no cleaning schedule in place for carpets and curtains.

• Data showed patient outcomes were comparable or lower than the locality and nationally.

• All the patients we spoke with said they were treated with compassion, dignity and respect.

• Urgent appointments were usually available on the day they were requested.

• The practice had policies and procedures in place to govern activity.

• The practice proactively sought feedback from patients and had a virtual patient participation group (PPG). The practice asked the opinions of these group members although the PPG did not meet in person they were actively involved in the practice.

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. However the practice did not have access to an automated external defibrillator.

The areas where the provider must make improvements are:

• Ensure refrigerators used for the storage of vaccines are monitored correctly.

• Implement a system to ensure all medication is stored and rotated correctly and used within their expiry date.

• Ensure all single use equipment, such as urine test strips, blood glucose strips, needles, syringes, oro-pharyngeal airways and swabs are stored correctly and within their expiry date.

• Ensure checks of emergency equipment such as medical emergency oxygen are carried out regularly and documented.

• Ensure equipment for the disposal of sharp instruments are labelled and closed when not in use.

• Ensure there is a cleaning schedule is implemented for carpets and curtains.

• Ensure blind cords are secured with a cleat.

• Consider availability of an automated external defibrillator (AED) or undertake a formal risk assessment if a decision is made to not have an AED on-site.

In addition the provider should:

• Assign roles to all staff with specific job descriptions and ensure staff are aware of the roles and responsibilities they have.

• Keep medicines stored in a locked cupboard.

• Advertise that chaperones are available to patients on request and formalise any training for reception staff who act as chaperones.

• Review where the practice complaints policy is displayed so patients can access the information easily and review the external agency information.

• Review how information, such as policies are disseminated to staff.

• Maintain a record of immunity of all clinical staff. Including a record of the Hepatitis B status of all clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had a recruitment policy in place to ensure that staff were suitable and authorised to be employed in their roles.

Patients expressed their views and were involved in making decisions about their care and treatment. We saw that patients were given information and support with regards to treatment options and that staff maintained patient’s privacy and confidentiality.

One patient who spoke with us said they were treated with respect and the care they received was “Fantastic.” We saw comments from other patients recorded in surveys completed in 2013. Patients had written “No improvements to service needed” and “I am happy with the service”.

We found the environment to be clean, tidy and organised. We saw there were systems in place to reduce the risk and spread of infection. One patient who spoke with us told us “The hygiene and cleanliness of the practice is okay, but the environment is looking a bit worn and dreary.”

Patients who used the service were potentially at risk of receiving care from staff who were not considered suitable to work with vulnerable people as effective recruitment procedures and checks had not been undertaken before staff began work.

Staff had received appropriate professional development and training to ensure they could meet the needs of the patients who used the service. Staff could tell us who they would contact if they were concerned about child protection issues or abuse of patients. The practice had systems in place to assess and monitor the quality of the service that patients received.