We carried out an announced comprehensive inspection on 24 January 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The provider which is Kingfisher Family Practice is registered with the Care Quality Commission to provide surgical procedures in conjunction with and located at John Coupland Hospital, Ropery Road, Gainsborough, Lincolnshire, DN21 2TJ.

A GP partner employed by Kingfisher Family Practice is the registered manager for this service. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager is also the lead clinician for this service who carries out all surgical procedures.

Kingfisher Family Practice provide a one-stop-shop, community day case service for carpal tunnel syndrome and trigger finger surgery for patients over the age of 16 and has been operating since 2010. This service is commissioned by all four clinical commissioning groups (CCG) within Lincolnshire and is a demand led service, clinics are held on a monthly basis, at John Coupland Hospital in a surgical day case unit environment. John Coupland Hospital is a community hospital managed by Lincolnshire Community Healthcare Trust (LCHS).

Patients are referred into this service by their registered GP via an electronic choose & book system or by a GP referral letter. The provider employs a support administrator who co-ordinates this service and is based at Kingfisher Family Practice.

The service is managed by a team of staff which includes a GP partner / lead clinician, a practice manager, a business manager and a carpal tunnel support administrator. Nursing support is provided by staff employed to work at John Coupland Hospital by LCHS and includes a healthcare support worker (HSW), nursing staff are managed by a surgical sister.

The provider is not required to offer an out of hours service. However, patients are provided with a 24 hour emergency help line number for use in an emergency. Also, patients who need emergency medical assistance out of corporate operating hours have the option to seek assistance from alternative services such as the NHS 111 telephone service or accident and emergency. This is detailed on the Kingfisher Family Practice website and its patient guide.

Our key findings were:

• There was an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed. The surgical day case unit had adequate arrangements in place to respond to emergencies and major incidents.

• A process was in place to ensure all patients undergoing a planned surgical procedure were screened for Multi Resistant Staphylococcal Aureus (MRSA) infection.
• Surgical pathways were completed in accordance with the ‘World Health Organisation’ (WHO) surgical safety checklist.
• Staff sought patients’ consent to care and treatment in line with legislation and guidance. Before patients received any care or treatment they were asked for their written consent and the provider acted in accordance with their wishes.
• The provider did not have an effective tracking system in place to ensure they were aware of any post-operative complications for those patients who were required to have their sutures removed by their own GP practice to ensure these patients can be monitored.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• The provider actively encouraged patient feedback and acted upon it.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The provider and John Coupland Hospital each had a comprehensive business continuity plan in place which ensured staff knew how to deal with events that affected the service.

There were areas where the provider could make improvements and should:

• Review processes in place to ensure the provider has a tracking system to ensure they are aware of any post-operative complications for those patients who are required to have their sutures removed by their own GP practice to ensure these patients can be monitored.