Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swallownest Health Centre on 15 June 2016. The overall rating for the practice was Good with requires improvement for safety. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Swallownest Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 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 15 June 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:

• Recruitment had been improved to ensure the necessary employment checks were in place for all staff.
• Systems to prevent and control the spread of infections had been improved. Staff training and procedures to monitor the standards of cleaning and improve stock control of sterile equipment had been implemented.
• Blank prescription forms and patient records were securely held.

The provider should make improvements in the following areas:

• Develop systems to analyse significant events to assist in identifying patterns and trends and to review the effectiveness of action taken to minimise the risk of reoccurrence following an incident.

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 Swallownest Health Centre on 15 June 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• There were arrangements for identifying, recording and managing risks, issues and implementing mitigating actions. However, there was a lack of oversight and monitoring of some areas of health and safety, cleaning standards and stock control. There were also shortfalls in recruitment and records management.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had received training to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, staff had not received infection prevention and control and fire safety training.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently positive.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and continuity of care was a priority for the practice. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

The practice made continuity of care for patients a priority. For example:

They had arranged the appointments system to encourage continuity of care by providing 50% of their appointments which could be booked up to 12 weeks in advance. All the staff were focused on continuity of care and offered appointments with the patients usual GP where ever possible. Home visits were also arranged with the patients usual GP. Patients told us they could easily book an appointment with a named GP within a reasonable timescale. Data showed 52% of patients could always or almost always see or speak to the GP they prefer compared to the CCG and the national average of 36%.

The practice had also implemented a care home service in a way that gave continuity of care for patients. They had done this by providing a set visit day and time with the same GP. Staff at the care home attended by the practice confirmed the arrangements and said the practice concentrated on providing consistency for patients. They said the GP responsible for the home was always available by telephone or email. The home manager was also invited to the practice monthly multidisciplinary meeting to discuss the care plans for their patients. They told us this arrangement worked to the benefit patients and their families and they gave examples of positive care outcomes for patients related to the continuity of care provided. They said this service had reduced admissions to hospital and the need for patients to attend the accident and emergency department and use of the out of hour’s service. The practice had provided this initiative for a number of years, initially without any extra remuneration, although since April 2016 Rotherham CCG had provided extra payments for care home patients as an enhanced service.

The areas where the provider must make improvement are:

• The practice must take immediate action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff.

• Ensure systems to prevent and control the spread of infections are improved such as providing staff training and implementing procedures to oversee and monitor the standards of cleaning and stock control of sterile equipment.

• Securely store prescription forms held in GP consulting rooms.

The areas where the provider should make improvement are:

• Develop and implement systems, such as written protocols, so learning from significant events is cascaded to new staff and supports staff when dealing with the same situation in the future.
• Develop and implement systems to review the effectiveness of action taken to minimise the risk of reoccurrence following an incident.
• Securely store patient records held in GP consulting rooms.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Patients expressed their views and were involved in making decisions about their care and treatment. We saw that patients were given information and support with regards to treatment options and that staff maintained patient’s privacy and confidentiality.

We spoke with ten patients including a representative of the ‘Patient Participation Group’ (PPG) they told us they were treated with respect and the care they received was “Very good.” Patients told us they were very happy with their experience of the practice and said the practice nurses were very thorough and explained everything to them. One patient said, “I find the practice is very good at responding to medical emergencies, I phoned up this morning, told them my problem and I was given an appointment straight away.”

We found the environment to be clean, tidy and organised. We saw there were appropriate systems in place to reduce the risk and spread of infection. Patients said “The practice is clean and modern, the facilities are excellent.”

Staff had received appropriate professional development and training to ensure they could meet the needs of the patients who used the service.

Staff were familiar with the procedures to report any issues or abuse of patients.

The practice had systems in place to assess and monitor the quality of the service that patients received. One patient said, "I am involved in improving the patient experiences at the practice, and we are getting there, it's very good."