Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ibstock House Surgery on 27 October 2016. The overall rating for the practice was requires improvement. The ratings for providing an effective, caring and responsive service were good but the ratings for providing a safe and well led service were requires improvement as we identified a breach in regulations. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Ibstock House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 29 June 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 27 October 2016. This report covers our findings in relation to those requirements.

Overall the practice is now rated as good and the ratings for providing a safe and well led service are also good.

Our key findings were as follows:

• An action plan had been compiled and completed to strengthen infection control processes. This included the infection control lead nurse attending a training course to support them in their role and infection control audits had been completed for both sites and actions identified in the audit had been addressed.

• A log of safety alerts was now kept and actions taken and responsibility for actions were recorded. However we found that there was no evidence of some safety alerts prior to the log being commenced in November 2016 having been acted upon. Following our inspection the practice reviewed all safety alerts from the previous year and acted on them as necessary.

• The cold chain policy had been updated and all staff had been made aware of it to ensure they were fully aware of all aspects of the cold chain process and required actions.

• The process for reporting, recording, acting on and monitoring significant events had been further improved and reviews took place every three months. We saw that non clinical incidents were also reported.

• The system for identifying carers had been reviewed and the number of carers on the practice register had increased significantly.

• Clinicians now participated in appraisals for clinical staff.

• Cleaners and drivers employed by the practice had now completed training relevant to their role and undertaken Disclosure and Barring Service checks.

• The practice had carried out a staff survey and taken other steps to evaluate staff satisfaction and acted on feedback received. Staff we spoke with told us they felt supported by their peers and management.

We saw one area of outstanding practice:

The practice hired a mini bus twice a week and employed a driver to provide free transport for patients to and from the practice to attend their appointments. The minibus was wheelchair accessible by means of a lift which also allowed patients with limited mobility who may have struggled to use bus steps to access the transport.

The bus could be used by any patients but was generally used by elderly patients who had no other means of getting to the practice, particularly as some areas served by the practice had no public bus service. Other patients who would not have been able to walk the distance to or from a bus stop. due to lack of mobility also benefitted from the service.

Patients were made aware of the service by means of the practice leaflet, the practice website, word of mouth or by staff suggesting it’s use. For example, one patient was phoned by a GP in the morning and assessed as needing to be seen in the practice. The GP communicated with reception to organise a place on the minibus which co-ordinated with an appointment and the patient was seen in the practice two hours later.

The areas where the provider should make improvement are:

• Continue to make efforts to further increase the number of carers identified, including young carers.

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 Ibstock House Surgery on 27 October 2016. Overall the practice is rated as requires improvement.

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 reporting and recording significant events however not all incidents had been recorded.
• Risks to patients were assessed and well managed.
• 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.

• Data from the national GP patient survey showed patients rated the practice lower than others for most aspects of care.

• Comments about the practice and staff were wholly positive.
• 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.
• Appointments were operated on a triage basis. Patients that rang for an appointment were added to a GPs triage list and the GP telephoned the patient to either give a telephone consultation or book the patient into an appointment with the relevant clinician.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place however not all staff felt supported by the partners and management
• The provider was aware of and complied with the requirements of the duty of candour.

• Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons. However we saw no evidence the practice carried out reviews and completed searches on the patient record system to ensure action was taken against the alerts. The practice had recently changed computer systems and it was not possible to review the older alerts.

• The practice offered extended hours with online prebookable appointments available from 7.20am Monday to Friday.

• The practice had recently changed computer systems which meant that at the time of the inspection they had identified 58 patients as carers (0.5% of the practice list). The practice waiting area did not display any support or signposting for carers services.

• The premises were visibly clean and tidy. The practice nurse who had been the infection control lead had left the practice and the practice did not have a copy of a recent infection control audit.

• Staff at the branch were not able to demonstrate their knowledge of the cold chain procedure. Although temperatures were checked and within the required range the staff we spoke with were unable to explain action they should take for any outside of this range

• All staff had received an appraisal within the last 12 months however some of the clinical staff appraisals had been completed without a clinician present.

The areas where the provider must make improvements are:

• Ensure infection control audit is completed and any actions identified are addressed.

• Ensure all staff that are part of the cold chain process understand the procedure and action that should be taken were necessary.

• Ensure processes for reporting and recording significant events, incidents and near misses is adhered to including non-clinical incidents.

The areas where the provider should make improvement are:

• Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it.
• Clinicians to be involved in appraisals for clinical staff.
• Review and assess relevant training considered as mandatory for cleaning staff and drivers.
• Review process for staff feedback to ensure that staff feel supported and that their feedback is valued.

• Embed new process for the management of safety alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice