In addition, the provider should:

• Review incident reporting to ensure these are recorded in a timely manner.

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 Patterdale Lodge Medical Centre on 10 March 2016. The overall rating for the practice was good however the practice was rated as requires improvement in safe.

At our previous inspection in March 2016 we rated the practice as ‘requires improvement’ in providing safe services. We issued two requirement notices to the provider relating to recruitment and staff training. The provider sent us an action plan and also assurances that they would mitigate any risks identified. The full comprehensive report on the 10 March 2016 inspection can be found by selecting the ‘all reports’ link for Patterdale Lodge Medical Centre on our website at www.cqc.org.uk.

This inspection visit was carried out on 11 October 2017 to check that the provider had met their plan to meet the legal requirements. The findings of this inspection were that whilst the provider had taken some action to meet the legal requirement notices insufficient action had been taken with regard to recruitment processes.

Overall the practice is rated as good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However the system to disseminate and share learning from incidents should be improved.

• Some improvements had been made to the recruitment process however gaps were still found in the information required to be held to ensure patients were treated and cared for by appropriately skilled and competent staff.

• Risks to patients were overall assessed and managed.

• Improvements had been made to the systems in place to monitor staff training.

• The practice had effective infection prevention and control systems in place.

• Medical equipment had been tested and calibrated since the last inspection.

• Staff were aware of procedures for safeguarding patients from the risk of abuse.

• The GPs were able to demonstrate how they used best practice guidance in the care and treatment provided to patients.

• Services were planned and delivered to take into account the needs of different patient groups.

• Information about services and how to complain was available. The practice managed complaints effectively.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the duty of candour.

The provider needs to make improvements.

Importantly, the provider must:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

In addition the provider should:

• Review how emergency drugs are stored and monitored.

• Review the process to monitor uncollected prescriptions.

• Carry out the legionella action plan to mitigate risk to staff and patients.

• Review the significant event process to ensure learning and actions are disseminated practice wide.

• Review the audit process to ensure outcomes are disseminated practice wide.

• Review the two week referral system to ensure it can be effectively monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Patterdale Lodge Medical Centre on 10th March 2016. Overall the practice is rated as good.

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

• The practice had a system in place to report significant events. Staff understood and fulfilled their responsibilities to raise concerns. However there was no formal system to analyse, discuss and share findings with the team which limited learning from all events.

• Some aspects of managing safety needed further review. The systems in place for monitoring prescription pads needed to be reviewed to show a clear audit trail of how they were stored and issued. Protocols were lacking in regard to managing prescriptions that had not been picked up by patients.

• Staff files lacked evidence of necessary medical questionnaires and induction checks were not in place for some staff including none in place for locum staff.

• The practice was clean and tidy. The last infection control audit identified further actions to help improve its overall score from 84%.

• The practice staff did not have access to a lone working policy.

• There were no protocols to identify appropriate clinical GP support for the triage service operated by the nursing staff.

• Some staff needed updated training such as: fire safety, CPR, safeguarding and the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards (DoLs.) Training needs had various gaps to help show appropriate management of updated training for all staff. Staff retention at the practice was good offering stability and continuity of care to patients.
• Patients were positive about the practice and the staff team. They said they were treated with dignity and respect and felt involved in decisions about their treatment.
• Information about services and how to complain was available but patients had to ask for this information from reception.
• Patients were positive about accessing appointments with a named GP and continuity of care.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The management of health and safety within the building was well managed by the practice.
• The Patient Participation Group (PPG) group felt they were instrumental in suggestion changes to help improve services such as the introduction of telephone consultations.

There are areas where the provider must make improvement. The provider must:

• Take action to ensure its recruitment policy, procedures and arrangements are improved to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held.

• Ensure all necessary updated training and induction is provided for all staff, including: fire safety, CPR , safeguarding, the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards (DoLS.)

• The areas where the provider should make improvement are:

• Ensure all significant events are shared with staff to promote learning.

• Ensure induction records are maintained and induction provide for all staff.

• Review access and availability of the complaints procedure and review ways of sharing reviews of complaints with the staff team.

• Review the auditing system for storage of blank prescription pads and protocols for staff when patients do not pick up their prescriptions.
• To review all policies and procedures to ensure they are up to date and accessible for all staff. Include access to a lone working policy and updates to the chaperone policy.
• To review the triage service operated by the nursing staff and develop protocols to ensure appropriate clinical GP support is identified.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice