Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jubilee Field Surgery on 15 December 2016. The overall rating for the practice was requires improvement. We found the practice to be inadequate for providing safe services, requires improvement for providing effective and well led services and good for providing caring and responsive services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Jubilee Field Surgery on our website at www.cqc.org.uk.

This announced comprehensive inspection was undertaken on 15 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 in December 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.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again. For example, the practice had responded quickly and effectively to issues raised at the previous inspection in December 2016.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• There was evidence of appraisals and personal development plans for all staff. For example, the practice had employed a nurse practitioner mentor to improve support and development for the nursing staff.
• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.

The areas where the provider should make improvements are:

• Ensure staff competencies are reviewed and current to their area of work.

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 Jubilee Field Surgery on 15 December 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.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• Nurses had received appropriate training and regular updates. However learning was not always appropriately applied. For example, management of vaccine temperatures in line with Public Health England guidance and ensuring equipment used for lung function testing was calibrated in line with nationally agreed guidelines.
• There was evidence of appraisals and personal development plans for all staff.
• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

However we found that patients were at risk of harm because systems and processes were not implemented in a way to keep them safe. For example:

• The arrangements for storage and managing the cold chain for vaccines did not keep patients safe. We looked at fridge temperature logs going back to 2011 and found recordings outside of recommended ranges on many occasions. There was no evidence that any action had been taken regarding this. This meant that the practice could not be sure that vaccines administered to patients during this period of time were effective and opportunities to prevent or minimise harm were missed.

• A fire risk assessment had been carried out by an external assessor. However many of the actions recommended had not been completed, for example installation of an integrated fire alarm system. The practice was unable to provide evidence which demonstrated that the recommended actions had been considered.

The areas where the provider must make improvements are:

• Ensure vaccine fridges are correctly monitored and actions taken and recorded appropriately.
• Ensure recommended actions are followed or risk assessed for fire safety.
• Ensure equipment is calibrated according to manufacturers recommendations.
• Ensure essential training is undertaken and able to be applied by staff throughout the practice, including infection control and Mental Capacity Act 2005 training.
• Review the emergency equipment checking process to include contents required and record checks.

In addition the provider should:

• The practice should improve the identification of patients who are also carers.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice