Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lepton & Kirkheaton Surgeries on 15 November 2016. This was to check that the practice had taken sufficient action to address a number of significant shortfalls we had identified during our previous inspection on 21 January 2016. Following this inspection, the practice was rated as inadequate for providing safe, effective and well-led services; and requires improvement for providing caring and responsive services. Overall it was rated as inadequate. We also issued three warning notices under the Health and Social Care Act 2008 to accompany our inspection report and placed the practice into special measures as a result.

During our most recent inspection, we found that the practice had taken action to remedy the breaches in regulations. For example, health and safety concerns had been addressed, outdated policies had been reviewed, effective clinical audits were being undertaken, deficits in staff training had been rectified and systems to ensure the safe management of vaccines had been implemented. Overall the practice is now rated as good.

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.
• 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.
• 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 easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 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.

The areas where the provider should make improvement are:

• Continue to review and address issues raised in the national patient survey to assure themselves that improvements that have already been made are sustained and have had a positive impact.

• Continue to address performance in the Quality and Outcomes Framework (QOF) in the area of mental health services to effect continued improvement.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 Lepton & Kirkheaton Surgeries on 21 January 2016. Overall the practice is rated as inadequate.

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

• The clinicians at the practice were skilled, compassionate and the two partners had joined the practice following a long period of upheaval and a high turnover of GPs. The practice, however, suffered from wide ranging systemic and management deficits.

• Patients were at an increased risk of harm because systems and processes were not in place to keep them safe. For example, there was limited learning from significant events, and actions arising from these events were not consistently implemented.

• There were inadequate safeguards for the monitoring of temperature sensitive vaccines.

• Some of the practice policies and procedures were out of date or undated and some contained obsolete information.

• Patient safety alerts were not appropriately managed. More than six months elapsed before the staff member with co-responsibility for monitoring and sharing alerts was added to the distribution list.

• A member of the nursing staff did not consistently follow the practice policy of referring all out of range blood results to GPs during disease reviews and had not received any recent clinical updates to support this decision making.

• There was no clinical supervision of nursing staff. Learning from complaints was not consistently undertaken and the practice had insufficiently addressed long-standing shortcomings in the attitude of a minority of reception staff.

• Patient outcomes were hard to identify as the practice had not undertaken any effective clinical audits or quality improvement.

• Patients were mostly positive about their interactions with staff and said they were treated with compassion and dignity. We found, however that patient survey results rated the practice lower than other practices in the area or nationally.

• The practice had no clear strategic plan.

• There was insufficient leadership capacity and limited formal governance arrangements.

• The practice had an active, supportive patient reference group who were engaged in supporting the new partnership.

The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Introduce effective processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and complaints.

• Take action to address identified concerns with out of date policies.

• Put systems in place to ensure all clinicians are kept up to date with national guidance, safety alerts and guidelines.

• Plan and carry out quality improvement initiatives to ensure improvements have been achieved.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.

• Clarify the practice management structure and ensure there is leadership capacity to deliver all improvements.

We have issued warning notices with respect to the following regulations of the Health and Social Care Act (2008):

• Regulation 12 – Safe care and treatment

• Regulation 17 – Good governance

• Regulation 18 – Staffing.

The practice is required to make improvements in order to comply with these regulations.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice