Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 8 April 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Park View Surgery on 5 December 2017 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous inspection programme.

At this inspection we found:

• The practice generally had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, actions to manage the low risk of legionella in the practice water system needed to be implemented. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings.) Also, risk assessments for staff working conditions and for emergency medicines held by the practice needed completion.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. There was a practice quality lead who managed many aspects of practice quality improvement.
• Staff acted on information in patient safety alerts although these actions were not always clearly documented.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw three areas of outstanding practice:

• The practice clinical pharmacist worked with the lead pharmacist for medicines management training at the hospital to improve the way that discharge summaries were written. This work had resulted in further training for both junior and senior pharmacists at the hospital and a revised protocol for producing patient discharge summaries for all patients discharged from the hospital. We saw evidence that the lead hospital pharmacist had affirmed that this work had reduced errors made in patient hospital discharge summaries and the practice confirmed that there were fewer observed inaccuracies since this intervention.
• The practice quality lead took the lead in working with the local safeguarding team and a home for children with complex needs. As a result of this, several changes to procedure were made, the home employed a nurse to act as a focus for the children’s health needs and communications with the children’s service were improved. The practice clinical pharmacist also visited the home to advise on the storage of medicines. Also, as a result of this work, staff from the local safeguarding team reviewed how all children known to the local child and adolescent mental health team were transferred from other areas and subsequently managed. This improved patient safety for all local practices with regard to the transfer of patients from outside the area.
• Practice staff worked closely with staff from a local women’s probation service facility. They arranged for staff from the service to attend a practice meeting in order to set up procedures for prescribing medicines for patients in the service. This improved procedure associated with prescribing for these patients and ensured better patient safety.

The areas where the provider should make improvements are:

• Continue to implement the policy to reduce the risk of legionella in the practice water system.
• Consider introducing a confidential health questionnaire to risk assess working conditions for new staff.
• Consider documenting a formal risk assessment for emergency medicines held in the practice.
• Look at improving the documentation of actions taken as a result of patient safety alerts.
• Continue to improve the identification of patients who are also carers.

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 Park View Surgery on 08 April 2015. We had previously inspected this practice in July 2014 and had identified some areas where they were not meeting the Health and Social care Act 2008 (Regulated Activities) Regulations 2010. We followed up on the action plan the practice had submitted to address the issues highlighted.

Overall the practice is rated as good. We found the practice to be good for providing safe, well-led, effective, caring and responsive services.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We also saw areas of outstanding practice:

• Although all staff recognised their responsibilities with regard to safeguarding. We were given specific details of where non clinical staff had been vigilant and acted outside of the usual expectation of this group of staff. They had alerted clinical staff to potential risk and this risk had been subsequently acted upon.
• The practice had been successful in securing funding to pilot a scheme whereby they had a Community Psychiatric Nurse (CPN) on their staff to promptly assist patients within the practice with their mental health crisis needs. The CPN was seeing patients that would otherwise have had to be referred on to local Mental Health Trust. Whose current waiting time for counselling was 11 weeks, Cognitive Behavioural Therapy was 13-17 weeks and for appointments with the Psychological wellbeing practitioners in Preston was 15-22 weeks. The CPN would see patients within a week and offer assistance and support.

In addition the provider should:

• Ensure there is an auditable system for reviewing and monitoring the recording of serial numbers on blank hand written prescriptions pads held in storage and once allocated to GPs.
• Should ensure they follow their policy on complaints and send patients a holding letter once they receive a complaint into the practice.
• Formally record and make available minutes of non-clinical staff meeting to all staff.
• Ensure if administration staff are to be used as chaperones they have adequate training.
• Ensure when carrying out minor surgery the GPs follow the practice policy and record written consent on the available forms and scan onto patients’ records and not just record in the minor operations log book.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Park View Surgery provides services that include access to GPs and nursing staff for diagnosis and treatment of conditions and illness, minor surgical procedures and ante and post natal health care for mothers and their babies.

Patients of the practice can access extended hours provision one evening a week at the practice. At all other times out of hours primary care is provided by Preston Primary Care Services at Preston Hospital.

Patients are positive about their experiences when they use services at Park View Surgery.  Staff and patients have opportunities to influence how the practice delivers services.

The practice provides treatment from a building that is clean. Staff regularly monitor different aspects of the service to ensure standards remain satisfactory.

The practice is registered to provide the following regulated activities: treatment of disease, disorder or injury; diagnostic and screening services; maternity and midwifery services; and surgical procedures.