Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northcote House Surgery on 13 December 2016. This inspection was a follow up to our previous comprehensive inspection at the practice in April 2016 where breaches of regulation had been identified. The practice was rated as inadequate for the domains of safe and well led, requires improvement in the domain of effective and good in the caring and responsive domains. The overall rating of the practice following the April 2016 inspection was inadequate and the practice was placed into special measures for a period of six months.

We also issued a warning notice to the practice to inform them where improvements were needed in relation to good governance. A visit was undertaken on 5 August 2016 where we saw that the specific improvements had been made.

At our inspection on 13 December 2016 we found that the practice had improved. The ratings for the practice have been updated to reflect our recent findings. The practice is rated as good for providing safe, effective, caring, responsive and well led services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with others for most aspects of care.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 well 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.

The area where the provider should make an improvement is:

• Proactively identify carers so that these patients receive appropriate support and care.
• Ensure that a comprehensive schedule of clinical meetings is in place.

I confirm that this practice has improved sufficiently to be rated good overall. This practice will be removed from special measures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This inspection took place so that we could follow up enforcement action that we had taken after our comprehensive inspection on 20 April 2016. The inspection report at that time rated the practice as inadequate overall and the practice was placed into special measures. You can find the report for the comprehensive inspection on the CQC website (www.cqc.org.uk).

Following the comprehensive inspection we issued a warning notice to the practice because there was immediate risks to patients that required urgent attention by the practice in relation to good governance. This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We returned on 5 August 2016 to ensure the practice had taken action to mitigate these risks and complied with the regulations. We found the provider had made appropriate improvements in ensuring that suitable arrangements were in place to improve systems to monitor the quality and safety of the service and ensure that staff received sufficient training and support.

We found that:

• Governance systems had been strengthened and provided evidence to demonstrate that quality improvements were being identified and actioned to promote improvement.
• Evidence to support recruitment checks had improved and staff who required disclosure and barring service checks (DBS) had received these.
• Appropriate calibration of equipment had taken place.

We found the provider should also:

• Ensure that a legionella assessment is undertaken and resulting actions implemented if required.

The practice continues to operate within the special measures applied by the CQC and will continue to do so for a total of six months from the publication of the report. After this time, CQC will revisit and re-inspect the practice and will amend our judgements and ratings in accordance with our findings at that time.

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 Northcote House Surgery on 20 April 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, actions identified to address concerns with infection control practice had not been taken.
• Significant events were not adequately managed or recorded.
• Patients were positive about their interactions with most staff and said they were treated with compassion and dignity by those staff members.
• The practice’s branch location in Fenstanton had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear leadership structure, but insufficient leadership capacity and limited formal governance arrangements.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The area where the provider must make an improvement is:

• Ensure appropriate security systems are in place so that only authorised practice staff can access the dispensary.
• A risk analysis must be carried out on the safe transport and storage of medicines to the branch surgery at Fenstanton.
• Ensure all emergency prescriptions issued are signed by a GP before being issued to a patient.
• Ensure that staff caring for patients have undergone a Disclosure and Barring Service check (DBS).
• Ensure all staff training deemed mandatory by the practice is up to date, including training for safeguarding.
• Ensure all policies, procedures and guidance are up to date so that staff are able to operate in accordance with up to date procedures.
• The provider must have an adequate infection control system in place to ensure that patients and staff are adequately protected.
• The practice must comply with relevant Patient Safety Alerts issued from the Medicines and Healthcare products Agency (MHRA) and through the Central Alerting System (CAS).

The areas where the provider should make improvements are:

• Improve confidentiality at the front desk and in the hallway at the St Ives location as well as for phone calls.
• Ensure thermometers used to record refrigerator and room temperatures where medicines are stored are validated before use to ensure their accuracy. In addition, the automated external defibrillator must be checked and serviced at regular intervals and at least annually.
• Ensure actions from the legionella assessment are undertaken.
• Ensure effective control of substances hazardous to health is in place.
• Ensure blank prescription forms are kept securely at all times.
• Significant events, complaints, (medicines) audit results and the associated learning should be shared across practice staff teams to ensure that lessons are embedded and to prevent reoccurrence of errors.
• Ensure staff receive timely appraisals and support.
• Ensure chaperone training is available for all staff undertaking such duties.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice