Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Red Lion Road Surgery on 11 May 2016. The practice was rated as requires improvement overall. A breach of legal requirements was found relating to the Safe, Caring, Responsive and Well-led domains. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulations 12 (Safe care and treatment), 17 (Good governance) and 16 (Receiving and acting on complaints) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that all significant events were fully recorded and that lessons were learned from incidents, they had failed to monitor patients in line with prescribing guidelines, they had failed to put processes in place to ensure that results were received for all clinical samples sent for analysis, they had failed to ensure that they had sufficient medicines available to be able to effectively respond to a medical emergency, they had failed to analyse and address concerns raised via the NHS GP Patient Survey, and they had failed to operate effectively an accessible system of identifying, receiving and recording complaints. We also identified areas where improvements should be made, which included reviewing how they identified patients with caring responsibilities, ensuring staff had clear guidance on the allocation of emergency appointments, ensuring that a locum pack was available, reviewing access to toilet facilities to patients, and ensuring that all staff were aware of how to use the electronic record system effectively.

We undertook this announced focussed inspection on 28 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Red Lion Road Surgery on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe, caring, responsive and well-led services.

Our key findings were as follows:

• The practice had an effective system in place for reporting and recording significant events. Learning from significant events was shared with staff in order to make improvements to safety.
• Since the initial inspection, the practice had conducted a comprehensive search of their patient records system to identify patients with caring responsibilities. They had identified 124 patients, which represented 4% of the practice list, and we saw that these patients were flagged on the system so that staff could easily recognise them.
• The practice had an effective system for recording verbal complaints. We saw evidence that all staff were engaged in this process and that complaints were discussed in practice meetings in order that learning could be shared.
• The practice had sufficient stocks of all medicines necessary to respond to a medical emergency on the premises.
• The practice had introduced a new process for tracking uncollected prescriptions, which was administered by a nominated member of reception staff, who checked for uncollected prescriptions weekly and took appropriate action on each prescription, as directed by a GP. A record was kept which showed the action taken in respect of each uncollected prescription.
• The practice had processes in place to ensure that all relevant staff received medicines updates and safety alerts.
• The practice had systems in place to ensure that patients were only prescribed medicines once the appropriate monitoring had been completed, in line with current guidance on the prescribing of medicines.
• The practice had auditable systems in place to ensure that results were received for all clinical samples sent for analysis.
• The practice had introduced written guidance for reception staff on the criteria for offering patients emergency appointments; however, there was a lack of consistent understanding amongst staff about the way that this guidance should be applied, and the practice had not actively sought feedback from staff about the effectiveness of this guidance.
• A locum pack was available to ensure that temporary GPs had easy access to information they needed.
• The practice had considered the access to toilet facilities for patients but had decided that the arrangements in place were appropriate.
• We observed that all staff were competent at using the electronic patient record system and that an ongoing programme of training was undertaken by the practice manager in order to keep up with changes to the system.
• The practice had carried-out its own patient survey using the same questions as the National GP Patient Survey in order to gather patients’ views on their service following changes they had made in response to the national survey. This survey showed a significantly higher rate of patient satisfaction compared to the national survey.

The areas where the practice should make improvements are:

• Continue to analyse the results of the national NHS GP Patient Survey when they are published, and consider ways to address areas of low satisfaction.
• Ensure that all staff are clear about the process for allocating emergency appointments, and consider seeking feedback from staff about the effectiveness of the new guidance.

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 Red Lion Road Surgery on 11 May 2016. Overall the practice is rated as requires improvement.

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; however, the process for recording significant events was not sufficiently robust to capture information about all safety incidents and ensure that learning occurred.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, we noted some cases where medicines had been prescribed either without the recommended monitoring having taken place or without the practice having access to relevant test results. We also noted that there was no process in place to follow-up patients who had not collected their prescription; nor were there sufficient processes in place to ensure that results were received for all histology samples that were sent for analysis. The practice’s arrangements for responding to medical emergencies and their storage of medicines were not sufficiently robust.
• Permanent staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. There was no locum pack available.
• Patients we spoke to during the inspection, and most of the CQC patient comment cards, reported that patients felt they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment; however, this was not reflected in the outcome of the NHS patient survey, where the practice scored below average for these areas.
• The practice kept a list of carers, but the number idenfitied represented less than 1% of the practice list.
• There was a lack of information about how to complain and the recording of complaints was not sufficiently robust.
• Most patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. However, not all staff were clear about the criteria for offering patients emergency appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs; however, there was limited access to toilet facilities at one of the practice sites.
• There was a clear leadership structure and staff told us that the management team were approachable; however, we noted that the practice did not hold regular staff meetings.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• They must take action to make information about making a complaint more accessible to patients and ensure that they have robust processes in place to record information about complaints received.
• They must review their significant events procedure to ensure that the threshold for recording an incident as a significant event is sufficient to allow them to capture details of all safety incidents.
• They must ensure that they are adhering to current guidance with regards to the prescribing of medicines.
• They must ensure that they have sufficient medicines available in order to respond to a range of medical emergencies.
• They must put processes are in place to ensure that results are received for all clinical samples sent for analysis.

In addition the provider should:

• Take action to identify carers so they can be given the support they need.
• Ensure clear guidance is provided to staff regarding the allocation of emergency appointments.
• Ensure that information is available for locum staff to ensure that they are able to provide safe and effective care to patients.
• Review the accesss to toilet facilities for patients.
• Ensure that all staff are aware of how to use the electronic record system effectively.
• Ensure that they are taking action to analyse and address poor patient feedback.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice