Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stickney Surgery on 24 November 2016. The overall rating for the practice was requires improvement. Specifically we found the practice to be requires improvement in safe, effective and responsive and inadequate in well led. It was rated as good in the caring key question. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Drs Busch, Rhys-Davies & Rajput on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 October 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 24 November 2016. 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 an open and transparent approach to safety and a system in place for reporting and recording significant events and to ensure learning was cascaded to staff.

• There was an effective system was in place to record, analyse and prevent dispensing errors.

• There were effective systems in place to ensure all clinical staff were kept up to date with guidelines from the National Institute for Health and Care Excellence and all types of patient safety alerts.

• Information about services and how to complain was readily available and there was an effective system to ensure learning from complaints was cascaded to staff.

• Data from the Quality Outcomes Framework showed the practice to have significantly improved performance across a wide range of clinical indicators.

• There was an effective system to ensure patients with long term conditions were recalled for review.

• Staff had been recruited only after all the relevant checks had been undertaken to help ensure their suitability.

• All staff had received annual appraisal of their work and performance.

• New staff received a comprehensive induction.

• A notice informing patients of the availability of chaperones was clearly displayed.

• The practice had taken steps to significantly increase the number of identified carers since our last inspection.

• Staff we spoke with praised the new management and management structure and told us they felt empowered to perform and improve the service.

However there were areas of practice where the provider should make improvements:

• The practice should continue to support and encourage the Friends of Stickney Surgery with a view to the body becoming an effective patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Busch, Rhys-Davies & Rajput (Stickney Surgery) on 24 November 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events, however there was no effective system to ensure learning was cascaded to staff.
• No system was in place to record, analyse and prevent dispensing errors.
• Some clinical staff had been recruited and were working at the practice without all the relevant checks being undertaken to help ensure their suitability.
• Staff had not received annual appraisal of their work and performance.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Effective management of the dispensary was lacking.
• The practice was responsive to the needs of patients and tailored its services to meet those needs.
• Care and treatment was provided by dedicated and caring staff.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However the practice had not taken steps to identify carers.
• Information about services and how to complain was not readily available and there was no effective system to ensure learning from complaints was cascaded to staff.
• Patients said there was continuity of care and same day appointments were available.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a new leadership structure and staff told us they felt supported.
• Data from the Quality Outcomes Framework showed the practice to be significantly lower that both local and national averages across a wide range of clinical indicators.
• There was no effective system to ensure patients with long term conditions were recalled for review and staff we spoke with about this matter were unclear of the process.

The areas where the provider must make improvement are:

• Ensure that all appropriate recruitment requirements are completed before staff start work at the practice.

• Ensure that staff receive regular appraisal to enable them to carry out the duties they are employed to perform.

• Introduce a process to ensure that learning from significant events and complaints is cascaded to staff to help prevent recurrence.

• Improve the arrangements for the management of dispensary to facilitate ’near-miss’ recording and analysis.

• Take steps to ensure that there is effective system of recall for patients with long term conditions.

• In the absence of accurate coding for the purposes of QOF, make alternative arrangements to ensure the practice has a real time oversight of performance and patient outcomes.

• Ensure an effective systems in place to ensure all clinical staff are kept up to date with guidelines from the National Institute for Health and Care Excellence.

• Ensure that information on the complaints procedure is available and that there is an effective process for dealing with complaints and significant events and responding to those affected.

The areas where the provider should make improvement are:

• The practice should initiate meetings to discuss children subject to safeguarding. The practice should also consider identifying and monitoring children who did not attend appointments in secondary care.

• Take pro-active steps to identify and support carers.

• Display notices regarding chaperoning in patient waiting areas.

• Ensure continued monitoring of newly implemented process for repeat prescriptions.

• Take active steps to monitor and assess patient satisfaction and the systems currently in place were not effective.

• Continue to monitor the repeat prescription process to ensure its efficacy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice