Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at South Wigston Health Centre on 31 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for South Wigston Health Centre on our website at www.cqc.org.uk.

We found that the practice to require improvement in the safe, effective, responsive and well led key questions. It was rated as good for the caring key question.

Specifically we found that the practice must;

• Implement governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided. For example, maintenance of the cold chain and review of temperature monitoring of the refrigerators used to store vaccines and the authorisations for staff to administer medicines.

• Improve the process in place to ensure staff training is monitored and all staff are up to date with mandatory training appropriate to their role.

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.

• Gather patient views and experiences to ensure the services provided reflect the needs of the population served and ensure flexibility, choice and continuity of care.

• Develop ways to monitor impact and improve patient satisfaction with particular regard to phone access and routine appointments.
• Ensure that oxygen cylinder to be used in an emergency was below the recommended level.

We issued the practice with a Warning Notice for breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good Governance.

We also issued the practice with an Improvement Notice for breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment.

In addition we found that the practice should;

• Ensure sharps bins are assembled, signed, dated and replaced as per national guidance.
• Review and develop the current systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Improve the process for clinical meeting minutes to include audits and updates on NICE guidance.
• Ensure policies and procedures include information such as date, date of review and name of responsible person.
• Review the current processes in place for the recording and reporting of themes and trends from significant events and complaints.
• Re-introduce the use of special patient notes.

This inspection was an announced focused inspection carried out on 16 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 31 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as ‘Good’.

Our key findings were as follows:

• There was effective management of medicines requiring refrigeration.

• All staff were up to date with mandatory training appropriate to their role.

• There were formal governance arrangements in place to monitor risks and the quality of the service provision.

• There was an effective process to ensure that oxygen for use in medical emergencies was monitored and available for use.

• The practice continued to gather patient views and experiences on the quality of the services provided.

• The practice had responded to concerns regarding telephone access and the availability of appointments.
• Sharps bins were used in accordance with national guidance.
• There were systems in place to ensure all clinicians were kept up to date with national guidance and guidelines.
• Clinical meeting minutes showed that audits and updates on NICE guidance were discussed.
• Policies had been reviewed, dated and included the name of the person responsible for that policy.
• There was a system in place for the recording and reporting of themes and trends from significant events and complaints.
• Special patient notes had been re-introduced.

However, there was an area of practice where the provider needs to make improvements.

The provider should:

Continue to monitor, audit and improve patient satisfaction with telephone access and appointment availability.

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 South Wigston Health Centre on 22 April 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the April 2015 report can be found by selecting the ‘all reports’ link for South Wigston Health Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive carried out on 31 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 22 April 2015. This report will cover all the five key questions and include our findings in relation to those requirements and additional improvements made since our last inspection.

Following the most recent inspection we found that overall the practice was still rated as requires improvement. We acknowledged that improvements had been made but further work was required.

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

• There was a system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded and reviewed although this was not always in depth so that learning could be maximised.

• At this recent inspection we found that risks to patients were now well assessed. However we found that some processes for the management of risks to patients and others against inappropriate or unsafe care were not effective. For example, maintenance of the cold chain and review of temperature monitoring of the refrigerators used to store vaccines, patient specific directions and some areas of infection control.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Data showed patient outcomes were above local and national average.
• Clinical audits had been carried out but further information was required to evidence the improvements to patient outcomes and shared learning with the practice team.

• Patients were positive about their interactions with staff and said they were treated with compassion dignity and respect.

• 95% of patients who responded to the national patient survey in July 2016 had confidence and trust in the last GP they saw. Only 39% of patients said they could get through easily to the practice by phone compared to the CCG average of 67% and national average of 73%. This was 20% worse than the results from the January 2015 survey.

• Comments cards we reviewed and patients we spoke with told us that the appointment systems were not working well. They did not find it easy to make an appointment with a named GP but urgent appointments were available the same day.

• The national patient survey results had not been reviewed and actions put in place to improve the areas of concerns identified by the patients registered at the practice.

• Information about services and how to complain was available and easy to understand.
• There was a leadership structure in place and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.
• The governance framework currently in place to support the delivery of strategy and good quality care need to be reviewed.

The areas where the provider must make improvements are:

• Implement governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided. For example, maintenance of the cold chain and review of temperature monitoring of the refrigerators used to store vaccines, authorisations for staff to administer medicines and some areas of infection control. Improve the process in place to ensure staff training is monitored and all staff are up to date with mandatory training appropriate to their role.

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision. Gather patient views and experiences to ensure the services provided reflect the needs of the population served and ensure flexibility, choice and continuity of care.

• Develop ways to monitor impact and improve patient satisfaction with particular regard to phone access and routine appointments.

In addition the provider should:

• Ensure sharps bins are assembled, signed, dated and replaced as per national guidance.
• Monitor the triage call back system to evidence the prioritisation of clinical need.
• Review and develop the current systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Improve the process for clinical meeting minutes to include audits and updates on NICE guidance.
• Ensure there is information for carers available in the practice.
• Ensure policies and procedures include information such as date, date of review and name of responsible person.
• Put an action plan in place in response to information from the national patient survey, East Leicestershire and Rutland CCG listening booth comments.
• Review the current processes in place for the recording and reporting of themes and trends from significant events and complaints, review of safeguarding registers and the use of special patient notes.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

In addition to this I have issued a warning notice to the practice in regard to Regulation 17 Good Governance which the practice will have had to comply with by 5 May 2017.

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 South Wigston Medical Centre on 22 April 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice requires improvement for providing safe, responsive and well led services. It was providing an effective and caring service.

It also required improvement for providing services for all the population groups

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 there was scope to ensure that learning was disseminated more formally.
• 76.% of patients who responded to the national patient  survey said they recommend the surgery to others. 80% described their overall experience as good.
• Risks to patients were not assessed and well managed.
• Some audits had been carried out but we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a number of policies and procedures to govern activity, but these were over five years old and had not been reviewed since. The practice did not hold regular governance meetings and issues were discussed at ad hoc meetings.
• Some staff that we spoke with on the day of the inspection said that there were not enough staff to maintain the smooth running of the practice, for example, not enough nurses to keep the clinics running in line with patient needs.
• Urgent appointments were usually available on the day they were requested. However patients said that they had to wait a long time to get through by phone and get an appointment. The practice had recognised a lack of patient satisfaction around access to appointments and telephone access to the practice and were taking action to address this.

The areas where the provider must make improvements are:

• Ensure there is a robust system to manage and learn from significant events, near misses and complaints.
• Implement a robust system to ensure that National Patient Safety Alerts and Medical Healthcare Product alerts are disseminated to staff and that action is taken as necessary.
• Identify, assess and manage risks relating to the health, welfare and safety of patients, staff and other people who may be at risk within the practice. For example, risk assessments for, legionella, general office environment, disclosure and barring (DBS) and control of substances hazardous to health (COSHH), infection control and fire safety.
• Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include the checking of medical equipment and disclosure and barring checks for newly recruited staff.
• Ensure that staff have appropriate support, identified through a formal appraisal system to enable them to deliver the care and work they carry out in the practice.
• Ensure training records are maintained and available.
• Ensure staff have appropriate and up to date policies and guidance to carry out their roles in a safe and effective manner.

In addition the provider should

• Ensure all staff are aware that National Institute for Health and Care Excellence guidelines are available on the practice intranet.
• Ensure there is an up to date business continuity plan which includes risks and mitigating actions.
• Have a robust system in place to track prescription pads.
• Consider gaining patient views in the delivery of service and driving improvements. For example, the appointment system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice