Letter from the Chief Inspector of General Practice

We carried out a focused desk-based review of Lyme Regis Medical Centre on 4 August 2016 to assess whether the practice had made the required improvements.

We had previously carried out an announced comprehensive inspection at Lyme Regis Medical Centre on 2 February 2016 when we rated the practice as good overall. The practice was rated as requires improvement for providing safe care. We found that clinical rooms were not locked when left unattended. This presented a security risk in that blank prescription forms, and other equipment were not kept safe.

We asked the provider to send a report of the changes they would make to comply with the regulations they were not meeting at that time. The practice was able to demonstrate that they were meeting the standards. The practice is now rated as good for providing safe care. The overall rating remains as good.

This report should be read in conjunction with the full inspection report published on 31 March 2016.

Our key finding was as follows:

• There was an open and transparent approach to safety and an effective system in place for the management of blank prescriptions and security of clinical areas.

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 Lyme Regis Medical Centre on 5 and 10 August 2015 when we rated the practice as requires improvement overall. Specifically, the practice was rated as requires improvement for providing safe care, for providing responsive services and for being well-led, inadequate for providing effective care and good for being caring.

We inspected again on 02 February 2016 to assess the improvements made at the practice. Overall the practice is now rated as good.

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

• Staff in the Minor Injuries Unit now have appropriate access to clinical guidance to carry out their roles in a safe and effective manner.
• The Minor Injuries Unit now offers treatment appropriate to the training and skills of the staff on duty.

• 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 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.
• 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.

We saw one area of outstanding practice:

The practice had developed a ‘Better Balance’ programme to support people who were at risk of, or who had experienced a fall. This was a 10 week programme run by an occupational therapist and supported by a health care assistant. The programme consisted of: exercises to improve balance; educational sessions such as diet and fluid advice; visits from the sight and hearing team; falls prevention and a visit from the practice social worker.

The areas where the provider must make improvement are:

• Ensure that blank prescriptions held in clinical areas are kept securely at all times.

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 Lyme Regis Medical Centre on 5 August 2015; this was followed up by an unannounced inspection of the practice’s minor injuries unit on the evening of 10 August 2015. Overall the practice is rated as requires improvement.

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

• The practice provided standard General Practice services as well as a walk in Minor Injuries Unit run and staffed by the practice nurses. We found this Minor Injuries service was not safe and patients were at risk of harm because systems and processes were not in place to keep them safe.
• We have been in discussion with the practice to make immediate improvements. Actions have been taken to address staffing and skills and a review is underway of the services of the Minor Injuries Unit with NHS England as a result of our inspection.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed, with the exception of those relating to the Minor Injuries Unit.
• There was insufficient assurance to demonstrate people received effective care and treatment in the practice’s minor injuries unit.
• Data showed patient outcomes were comparable to other practices in the locality.
• 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.
• Urgent appointments were available on the day they were requested. However patients said that they had seen a number of different GPs or locum GPs and felt continuity of care was not always possible.
• 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 the practice management and by the wider organisation. The practice proactively sought feedback from staff and patients, which it acted on. There was a planned programme of meetings involving all staff members and staff groups.

• The practice provided advice on sexual health to young people from the local school. This service was offered without an appointment to young people registered with the practice or neighbouring practices. There was no school nurse in post and so the practice could not demonstrate the positive impact of this as it was unclear how young people were made aware of this service.

We saw areas of outstanding practice:

• The practice had developed a ‘Better Balance’ programme to support people who were at risk of or who had experienced a fall. This was a 10 week exercise programme, run by a health care assistant and supported by the occupational therapist. The programme consisted of: exercises to improve balance; educational sessions such as diet and fluid advice; visits from the sight and hearing team; falls prevention and a visit from a the practice social worker to explain social support and benefits.

The areas where the provider must make improvements are:

• Ensure staff in the Minor Injuries Unit have appropriate access to clinical guidance to carry out their roles in a safe and effective manner, which is reflective of current best practice.

• Ensure the Minor Injuries Unit only offers treatment according to the training and skills of the staff on duty.

• Ensure a review of training for all staff at the practice appropriate to their role and ensure any further training needed is delivered.

• Ensure that governance arrangements are robust and include an assessment of risks and patient outcomes associated with the provision of the minor injuries unit.

• Ensure the plan of audits includes the completion of clinical audit cycles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice