Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mundesley Medical Centre on 2 December 2015. One breach of legal requirements was found.

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment (2) (b). Systems and processes were not established and operated effectively to ensure that clinicians were overseeing and checking changes to patients’ prescriptions.

We undertook this focused inspection to check that they had followed their action plan to address the shortfalls and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

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 Mundesley Medical Centre on 2 December 2015. Overall the practice is 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.
• Staff assessed the needs of patients, and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• There were high levels of patient satisfaction with the service. This was demonstrated by the National GP Survey results, the 23 comment cards we received and by the patients we spoke with on the day of our inspection.
• Patients said they were treated with compassion, dignity and respect, and that they were involved in their care and decisions about their treatment.

• Patients with caring responsibilities were proactively identified and supported. 

• 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.

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

The area where the provider must make an improvement is:

• Systems and processes were not established and operated effectively to ensure that clinicians were overseeing changes to prescriptions. The provider must develop a protocol for GPs to check changes in patients’ medications following discharge from hospital in addition to the GP signing the prescriptions prior to the issue of medication.

In addition the provider should:

• Ensure that the regular audit system in place to review the effectiveness of non-clinical staff managing incoming correspondence is increased.

• Provide a robust arrangement for the security of medicines and prescription pads stored in the dispensary areas and medicine storage cupboard, ensuring that they are only accessible to authorised staff.

• Monitor near-miss dispensing errors to detect trends and ensure appropriate actions are taken to minimise the chance of similar errors occurring again.

Professor Steve Field CBE FRCP FFPH FRCG

During our inspection on 17 July 2014 we found the practice to be welcoming with friendly staff. Patients told us they were happy with the appointment system. One patient told us, “I can get an appointment quickly, particularly if there is something wrong with my children. They are happy to see them at the drop of a hat.”

We saw that guidance regarding consent was available to staff. The clinicians we spoke with had a good understanding of this. Patients and their representatives who we spoke with confirmed this.

Patients told us the staff treated them respectfully and were helpful. There was a system in place for the recall of patients with long term conditions. We saw evidence that this was provided to patients registered at the surgery and those registered patients who lived in residential care homes.

We saw that staff spoke politely to patients and visitors to the surgery. Consultations were carried out in private treatment rooms. One patient told us, “The nurse was very helpful. I was told what was wrong, they explained the medication and how to take it properly and that I needed to come back tomorrow.”

Information was clearly displayed for patients, including health promotion, access to support services and information about the practice and the services provided.

We saw that the practice worked in partnership with other services, to review unplanned admissions to hospital and plan care for patients identified as needing end of life care.

Staff we spoke with had a good understanding of safeguarding of vulnerable adults and children. We found that guidance and contact information regarding safeguarding was available to all staff.

All staff had access to appropriate support and training. We found evidence that staff had received regular training, supervisions and appraisals. Appropriate pre-employment checks had been carried out.

The patients we spoke with were happy with the practice and did not have any concerns or issues about the care and treatment they received. The practice had systems for monitoring comments and complaints to ensure that any issues raised were responded to appropriately and in a timely manner. When issues had been raised the practice had policies and procedures in place to deal with them appropriately.

We saw there were systems in place to ensure records were accurate and maintained.

We carried out an announced comprehensive inspection at Mundesley Medical Centre on 11 December 2018 as part of our inspection programme. The practice was previously inspected in April 2016 and rated as good.

Our inspection team was led by a CQC inspector and included a GP specialist advisor and a second CQC inspector.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

This means that:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• The provider had a detailed action plan in place to address shortfalls within the practice, such as upskilling staff to address issues with recruiting GPs.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• The practice was fully engaged with reviewing and monitoring the clinical service they offered and used this information to make changes and drive care. For example, the practice had an effective system to monitor patients on a range of medicines, including high risk medicines. This included monthly searches and recalls for patients due a blood test.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered. For example, the practice had introduced a new appointment system to ensure patients were seen by the appropriate clinician.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
• The practice encouraged continuous improvement and innovation. For example, they were supporting a nurse to gain a prescribing qualification including study time and mentorship.
• Many staff had won awards for the care they provided and the work that had been completed. This included awards for a GP, nurse and administration staff.
• Staff reported they were happy to work in the practice and proud of the changes that had been made.

We rated the practice as requires improvement for providing safe services because:

• The practice had not completed a fire risk assessment since November 2015. After the inspection, the practice sent us an updated fire risk assessment.
• The practice had not completed a full infection prevention and control audit. After the inspection, the provider informed us they would allocate time every month for further audits to be completed.
• Staff logged prescription stationary and they were stored securely, however they did not monitor their use. After the inspection, the practice informed us they had contacted the Clinical Commissioning Group to ask for advice on how to appropriately monitor prescription pads.
• Patient Group Directions (PGDs) had not been authorised. The practice acted on this immediately and signed them on the day of inspection.
• Staff were knowledgeable about the dispensing processes, however not all staff had signed the Standard Operating Procedures.
• The practice did not have full oversight of all safety alerts, however the alerts we checked had been actioned. On the day of inspection, the practice set up a log to monitor alerts and actions taken.

We found the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We found the provider should:

• Review Standard Operating Procedures to ensure staff have read and signed these.
• Embed the new system for monitoring patient safety alerts.
• Review and improve the system for the logging of prescription stationary to ensure this is in line with recognised guidance.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice