Letter from the Chief Inspector of General Practice

We first carried out an announced inspection of Lockfield Surgery on 12 May 2015; this inspection was conducted as part of our comprehensive inspection programme. In response to this inspection we undertook a responsive inspection on 28 April 2016 to ensure the practice had taken the appropriate action in relation to a breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

During our responsive inspection on 28 April 2016 we identified significant concerns with regards to the premises used for the branch surgery at Raynor Road. In order to keep patients and staff safe, the Care Quality Commission imposed an urgent condition to prevent the delivery of regulated activities from the branch surgery; this condition came in to effect from 5 May 2016.

Additionally, as a result of our responsive inspection the practice was rated as requires improvement for providing safe services. This was because breaches of legal requirements were found and we identified some areas where the provider must improve.

We undertook a focused inspection on 13 December 2016 to check that the provider had made improvements in line with providing safe and well led services. This report only covers our findings in relation to those requirements. You can read the report from our previous inspections by selecting the 'all reports' link for Lockfield Surgery on our website at www.cqc.org.uk.

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

• The provider continued to comply with the urgent condition imposed by the Care Quality Commission in relation to preventing the delivery of regulated activities from the branch surgery. We received assurance from staff to confirm that the Raynor Road branch no longer operated as a practice branch to provide services to patients and no longer operated as the provider’s workplace for staff.

• Staff were aware of their responsibilities to raise and report concerns, incidents and near misses. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

• During our responsive inspection in April 2016 we found that governance arrangements were not effective in some areas. This was heavily influenced by a lack of risk management in relation to the practices previous unsuitable branch premises.

• During our most recent inspection we noted that the branch was no longer operational and as a result, the risks associated with the branch premises had been mitigated.

• During our most recent inspection we noted effective governance arrangements in place such as well embedded practice policies for areas such as safeguarding and management of the cold chain.

• We also saw a range of comprehensive risk assessments in place where risks associated with health, safety, fire and infection control were well monitored and mitigated. There were effective systems in place for the management of risks to patients and there were adequate arrangements in place to respond to medical emergencies.

• Staff said they were confident in raising concerns and suggesting improvements openly with the management team. Staff expressed that they felt supported and part of a close team.

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 of Lockfield Surgery, with a visit to the branch site, Raynor Road Surgery, on 12 May 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to:

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

We undertook a responsive inspection on 28 April 2016 to ensure the practice had taken the appropriate action in relation to Regulation 12.

This report covers our findings in relation to the responsive inspection, where we were required to follow up on the safe and well led domains only. As this was a focused inspection the ratings for the remaining domains and population groups are unchanged following the earlier inspection on 12 May 2015.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lockfield Surgery on our website at www.cqc.org.uk.

During our inspection on 12 May 2015 we found that the practice had identified that the branch site at Raynor Road was not a suitable premises to deliver care and treatment and we saw plans in place to relocate during July 2015. However, as part of our focused inspection approach we found that the practice had not been able to relocate their branch surgery as planned. We therefore visited the Raynor Road branch surgery as part of this inspection.

During our inspection on 28 April 2016 we identified significant concerns with regards to the premises used for the branch surgery at Raynor Road. In order to keep patients and staff safe, the Care Quality Commission imposed an urgent condition to prevent the delivery of regulated activities from the branch surgery; this condition came in to effect from 1pm on 5 May 2016.

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

• We identified a number of significant concerns with regards to the premises used for the branch surgery at Raynor Road. The premises were unsuitable for people with mobility problems, for wheelchair users and for people with prams and pushchairs. Overall, the branch surgery required extensive maintenance and repair work; it was visibly cluttered in areas and appeared to be neglected.

• Patients were not being protected against the risk of unsafe care and treatment as a result of inadequate infection control at Raynor Road surgery.

• There were inadequate arrangements for managing emergency medicines and vaccinations across the practice.

• At Lockfield surgery there were some procedures in place for monitoring and managing risks to patients’ and staff safety. These included formal risk assessments to monitor safety of the premises including health, safety and fire risk. However, there were no procedures in place for monitoring and managing risks to patients and staff safety at Raynor Road surgery.

• Recorded significant events, incidents and complaints were discussed during monthly practice meetings to monitor actions and share learning. However, the systems to monitor safety were not embedded well enough across both practice locations.

• Although staff spoke positively about working at the practice, we found that some staff were unclear regarding the status of the plans to relocate the branch surgery at Raynor Road.

The areas where the provider must make improvements are:

During our inspection on 28 April 2016 we identified significant concerns with regards to the premises used for the branch surgery at Raynor Road. In order to keep patients and staff safe, the Care Quality Commission imposed an urgent condition to prevent the delivery of regulated activities from the branch surgery; this condition came in to effect from 1pm on 5 May 2016.

• The provider must ensure that they continue to comply with this arrangement.

• The provider must ensure adequate arrangements are in place for managing and mitigating the risk in the absence of emergency medicines.

• The provider must ensure that all the vaccination fridges temperatures are consistently recorded, in line with guidance by Public Health England.

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 Lockfield Surgery, with a visit to the branch site, Raynor Road Surgery on 12 May 2015. Overall the practice is rated as Good.

Specifically, we found the practice to require improvement for providing safe services. It was good for providing an effective, caring, responsive and well led service. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients’ needs were assessed and the practice planned and delivered care following best practice guidance.
• The practice had a well-established and well trained team with expertise and experience in a range of health conditions. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Lockfield Surgery was clean and hygienic and had arrangements for reducing the risks from healthcare associated infections. The practice had good facilities and was well equipped to treat patients and meet their needs.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe, the practice did not have a process in place for the testing of fire alarms and fire drills and fire risk was not assessed in the practice.
• The practice had identified that the branch site was no longer a suitable premises at which to deliver care and treatment and had plans in place to relocate during July 2015.
• Data showed patient outcomes were average for the locality.
• Information about services and how to complain was available and easy to understand.
• The practice had recognised that internal communication processes was an area which they needed to develop and improve.

The areas where the provider must make improvements are:

• Ensure fire risk is assessed and document fire risk assessments within the practice.

In addition the provider should:

• Ensure a consistent process is applied to recording fridge temperatures.
• Improve internal communication and consider introducing regular meetings involving the whole practice team, ensuring there are mechanisms in place to seek feedback from staff . This would provide opportunities to share information learning from significant events and complaints.
• Routinely document attendance and input at internal and external meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with 10 patients and six members of staff.

Patients told us they were treated with respect and that staff protected their right to privacy. A patient said: "I have never come across a problem. They are always friendly".

We saw that patients' views and experiences were taken into account in the way the service was provided. The patients we spoke with provided positive feedback about their care. A patient told us: "They have sorted me out". Emergency medicines and equipment was in place that enabled staff to respond to medical emergencies.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

We found that staff had received appropriate training for the roles they carried out. All staff had received annual appraisals with their line manager. This meant that staff were supported and assessed as being competent to carry out their roles.

The provider had systems in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. This demonstrated that on-going improvements were made for the benefit of the patients.