Letter from the Chief Inspector of General Practice

In May 2015 during a comprehensive inspection of Loddon Vale Practice, Hurricane Way, Woodley, Reading, Berkshire we found concerns related to the following: The recruitment of staff, management of medicines, systems to monitor risk, clinical audit, assessment of mental capacity, safeguarding and vetting of staff undertaking chaperone duties. The report setting out the findings of the inspection was published in September 2015. Following the inspection the practice sent us an action plan detailing how they would improve on the areas of concern.

We carried out an announced focused inspection of Loddon Vale Practice on 23 February 2016 to ensure the changes the practice told us they would make had been implemented and to apply an updated rating.

We found the practice had made significant improvements since our last inspection on 27 May 2015. We have re-rated the practice overall as good. Specifically, they had made improvements to the provision of safe, effective and well led services. The ratings for the practice have been updated to reflect our findings.

At this inspection we found:

• Risks to patients were assessed and well managed.
• Systems were in place to respond to national safety alerts.
• Staff had been trained to identify possible abuse and to report any concerns in this respect appropriately.
• Appropriate checks had been undertaken for staff who undertook chaperone duties.
• Care planning had been improved to involve the patient in their future care.
• Systems to manage medicines had been improved.
• The practice had enhanced their programme of clinical audit and audit was driving improvement in patient outcomes.

However,

• The practice had not improved on the number of patients with a learning disability who had received their annual health check in 2015.

The area where the provider should make improvement is:

• To ensure that all patients with a learning disability are offered an annual health check in 2016. Promote the benefits of such checks to this group of patients and their carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out a comprehensive inspection of Loddon Vale Practice, Hurricane Way, Woodley, Reading, Berkshire, RG5 4UX on Wednesday 27 May 2015. The practice had been inspected in 2013. We undertook this comprehensive inspection to look at all the services the practice delivered and to apply a rating.

Overall the practice is rated as requires improvement. Specifically the practice was rated as requires improvement for the provision of safe services, effective services and for being well led. The practice is rated as good for provision of caring and responsive services. The practice had undergone significant change in the previous eighteen months with two senior GPs leaving and a new practice manager coming in to post.

Our key findings were as follows:

• Patients were at risk of harm because systems and processes in place to keep them safe were operated inconsistently. For example appropriate recruitment checks on staff had not been undertaken prior to their employment.

• Response to medicine alerts was inconsistent and there was no system in place to corroborate that action required from medicine alerts had been completed. Travel vaccinations were not being administered in accordance with current legislation.

• The practice was responsive to patient feedback. The appointment system had been reviewed in 2014 and additional clinics were introduced. Patients we spoke with and comment cards received reflected an improvement in availability of appointments.

• The practice provided a range of services on site for the benefit of patients. These included physiotherapy, dietician clinics and talking therapies. The availability of these services reduced the need for patients to travel to hospital clinics or other locations.

• The practice was clean and tidy and the practice sought to reduce the risk of cross infection. Close monitoring of cleaning and hygiene standards was undertaken.

• The practice had effective systems in place to care for patients with long term medical conditions and achieved high standards for this group. It was also active in promoting health screening and healthy lifestyles.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand

• There was an emerging cohesive management team and staff felt well supported to fulfil their roles. However, governance arrangements were not always consistently operated because improvement actions identified were either not taken or not completed in a timely manner.

• The practice had gone through a period of change in GPs and nursing staff and recent patient surveys were showing an improvement in patient opinion in being treated with compassion and respect.

• The practice was proactive in undertaking assessments of risk. For example a detailed audit of health and safety had been carried out. However, we found evidence that action identified to reduce risk was not completed in a timely manner.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure actions required to reduce health and safety risks are completed. Including the regulatory requirement to have a fire risk assessment in place. Ensure combustible materials are not kept on fire exit routes. Ensure outstanding matters from the legionella risk assessment are completed.

• Expand the range of clinical audits undertaken and institute an audit plan that includes completion of audit cycles to monitor clinical quality and systems to identify where action could be taken.

• Consistently operate a system to ensure action required from medicine alerts is completed and ensure all Patient Group Directions are appropriately completed and signed.

• Institute a checking system that ensures action arising from MHRA alerts has been completed. Ensure all patient group directions are fit for purpose and appropriately signed off. Complete the staff checks required by legislation.

• Ensure all practice nurses and health care assistants have completed Disclosure and Barring Service (DBS) checks (These checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

• Undertake appropriate training in the application of the Mental Capacity Act 2005 and consent regulations for patients under the age of 16. Staff must be able to recognise when patients may not have the mental capacity to give consent.

• Ensure practice nursing staff and health care assistants are trained to level two in child safeguarding or that training plans identify they are working towards this level.

In addition the provider should:

• Ensure all staff are aware of their training plan.

• Increase the number of annual physical health checks for patients with a Learning Disability and document when the patient does not consent to their annual review.

• Ensure that admission avoidance care plans are fully completed with basic data and that patient agreement to the plan is obtained.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We spoke with four patients, four doctors, the practice manager and reception staff. Patients told us they were treated with respect and were satisfied with the care and advice they received. We looked at nine care records and saw care and treatment was planned to meet people’s needs. We spoke with the Patient Participation Group (PPG). The group represents the views of patients and raises concerns or suggestions to the practice. The PPG informed us the practice was actively involved and was receptive to suggestions raised.

The building was purpose build and met the needs of the patients. Necessary checks where completed to ensure the safety of patients and staff. This included fire safety equipment and electrical checks. We found the building was well maintained and suitable for patients who use wheelchairs.

We reviewed the recruitment policy and found this was in line with regulations. This made reference to a full employment history with written explanation of gaps and a medical questionnaire. Photographic identification and references would be requested including where candidates had worked with children or vulnerable adults previously. Checks with the Disclosure and Barring Service would be completed for specific roles.

We saw effective systems were in place to deal with complaints. Patients were given information regarding making a complaint in a leaflet. This included Information on how to receive assistance from an independent advocacy service if required.