Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lincoln House Surgery on 5 April 2016. The overall rating for the practice was requires improvement. The full comprehensive report from the 5 April 2016 inspection can be found by selecting the ‘all reports’ link for Lincoln House Surgery on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 - safe care and treatment.
• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 - good governance.
• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 - staffing.

The areas identified as requiring improvement during our inspection in April 2016 were as follows:

• Ensure an appropriate system was in place for the safe use and management of medicines, medical consumables and prescriptions, including those used in an emergency.
• Ensure a plan of action to control and resolve risks identified by the Legionella risk assessment was completed. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
• Ensure that a comprehensive business continuity plan was in place so that a service could be maintained in the event of a major incident.
• Ensure that staff who act as chaperones were appropriately trained.
• Ensure that all staff employed were receiving appropriate supervision and appraisal.

In addition, we told the provider they should:

• Ensure that all staff completed a formal programme of infection control training.
• Take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance were improved.
• Take steps to improve access to the practice by telephone.
• Continue to identify and support carers in its patient population.

We carried out an announced focused inspection on 14 December 2016 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 5 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting regulations that had previously been breached.

Overall the practice is now rated as good.

On this inspection we found:

• There were appropriate arrangements in place for the safe use and management of medicines, including emergency medicines, vaccines and medical consumables.
• Blank prescription forms and pads were securely stored and there were systems in place to monitor their use.
• Appropriate Legionella management processes were in place.
• Arrangements were in place to respond to emergencies and major incidents.
• Staff who acted as chaperones were appropriately trained for the role.
• A programme was in place to ensure all staff received an appraisal on an annual basis.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• A programme of infection control training was in place and all staff had completed this.
• The practice discussed their below average satisfaction scores from the National GP Patient Survey published in January 2016. They demonstrated they had taken action to improve these including reducing the administration and managerial workload of the GPs and increasing the amount of patients accessing their online facilities such as appointment booking. The results from the National GP Patient Survey published in July 2016 showed improvement in all the areas previously of concern. The practice was now mostly performing in line with local and national averages. Senior staff at the practice were aware of any current areas of below average satisfaction scores and could demonstrate they were responding to it.
• Through additional training for some staff and a targeted approach the practice had increased the amount of carers identified in its patient population. As of December 2016 the practice had identified 145 patients on the practice list as carers. This was approximately 1.2% of the practice’s patient list and was an increase of around 48% from our inspection in April 2016.

Following our inspection on 14 December 2016 the area where the provider should continue to make improvement is:

• Ensure that all non-clinical staff are supported by receiving appropriate supervision and appraisal.

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 Lincoln House Surgery on 5 April 2016. Overall the practice is rated as requires improvement.

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

• There was an effective system in place for reporting and recording significant events.
• The practice had some clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. However, some of the practice’s systems and processes designed to keep patients safe were insufficient. These included the safe use and management of medicines.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. However, staff who acted as chaperones were not appropriately trained and the practice’s programme of staff appraisals was insufficient.
• Information about services and how to complain was available and easy to understand.
• Patients gave a mixed response about access to the practice and appointments. However, all patients were positive about access to urgent appointments and appointments available the same day.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• Although the practice had an overarching governance framework which supported the delivery of the strategy and good quality care, it was insufficient in ensuring the implementation of and adherence to some systems, processes and procedures.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure an appropriate system is in place for the safe use and management of medicines, medical consumables and prescriptions, including those used in an emergency.
• Ensure a plan of action to control and resolve risks identified by the Legionella risk assessment is completed.
• Ensure that a comprehensive business continuity plan is in place so that a service could be maintained in the event of a major incident.
• Ensure that staff who act as chaperones are appropriately trained.
• Ensure that all staff employed are receiving appropriate supervision and appraisal.

In addition the provider should:

• Ensure that all staff complete a formal programme of infection control training.
• Take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are improved.
• Take steps to improve access to the practice by telephone.
• Continue to identify and support carers in its patient population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice