We carried out an announced comprehensive inspection at the Swan Surgery on 7 July 2017. The practice was rated as good for providing effective, caring, responsive and well led services and requires improvement for providing safe services. Overall the practice was rated as good.

We undertook a follow up focused inspection of Swan Surgery on 14 February 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Overall the practice is still rated as good, and has been rated as good for providing safe services.

Our key findings were as follows:

• All equipment and medicines in the GP bags were within the expiry date. There was a policy and log in place to support the new checking system.
• There was a system in place to record, learn from, and discuss incidents such as near misses in the dispensary.
• Dispensary staff had easy access to the standard operating procedures.

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 Swan Surgery on 16 June 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Swan Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 7 July 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 16 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The practice had implemented improved security arrangements. For example, liquid nitrogen was no longer stored in an open area. Alarms and telephones had been installed in the waiting areas that were not in view of reception staff, which ensured patients who may become more unwell had easy access to help.
• The practice had a number of policies and standard operating procedures (SOPs) to govern activity; we found that these were generally well managed. However, some SOPs used by dispensary staff were not the reviewed versions.
• The practice had processes and systems to ensure that when things went wrong patients were given a detailed explanation and an apology. However, we found the understanding of the system for reporting and recording significant events and near misses within the practice dispensary needed to be improved.
• The practice reported an annual stock check of the dispensary was undertaken; however the practice policy stated this would be undertaken every three months.
• On the day of the inspection we found five items including cannulas, syringes and a pair of gloves that were out of date in a GP bag.
• Patients said they were treated with compassion, dignity, and respect.
• Information about how to complain was easily accessible to patients to and the practice system to manage complaints had been improved.
• The practice had implemented effective clinical oversight to ensure clinical staff had seen incoming patient documentation appropriately.
• The recruitment arrangements had been improved; personnel files we reviewed contained necessary employment checks for all staff, including locum staff.
• The practice training systems had been improved, and training that the practice deemed mandatory was up to date and recorded effectively. In addition the training log recorded other training the staff had undertaken.

• Induction processes had been formalised, ensuring that all staff received an induction appropriate to their role and that the induction process was completed in an effective manner.
• The practice had implemented systems and processes to ensure that patient safety alerts were appropriately managed.
• The practice had implemented improved communication methods to ensure that information was shared with any relevant staff or health professionals. For example, we saw minutes from multi-disciplinary team meeting where patients who may be vulnerable were discussed.
• Patients said they found it easy to make an appointment with a named GP and there were urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice liaised effectively with support organisations and proactively supported vulnerable patient groups.

However, there were also areas of practice where the provider needed to make improvements.

Importantly, the provider must:

• Monitor the systems and processes to ensure proper and safe management of medicines.

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 Swan Surgery on 16 June 2016. Overall the practice is rated as requires improvement.

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

• Staff understood their responsibilities to raise concerns and to report incidents and near misses. However, whilst reviews and investigations took place, there was scope to formalise learning from significant events.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, patients could potentially access liquid nitrogen that was located in an open area. Following the inspection the practice provided evidence that they had ensured patient access was not possible to areas concerned.
• The practice had a number of policies and procedures to govern activity, but some were not robust or followed correctly.
• Patients said they were treated with compassion, dignity and respect.
• On the day of the inspection information about how to complain was difficult for patients to access and there were inconsistencies with the practice policy and how the practice responded to complaints.
• Patients said they found it easy to make an appointment with a named GP and there were urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice liaised effectively with support organisations and proactively supported vulnerable patient groups.

The areas where the provider must make improvements are:

• Implement effective clinical oversight of the triage and filing of incoming patient documentation.
• Ensure recruitment arrangements include all necessary employment checks for all staff, including locum staff.
• Ensure that patients are not put at risk of harm from contact with hazardous substances and ensure that risk assessments are reviewed in a timely manner, for example fire risk assessment.
• Ensure that processes surrounding training systems are improved and ensure mandatory training for staff is up to date and recorded effectively.
• Formalise induction processes, ensuring that all staff receive an induction appropriate to their role and that the induction process is completed in an effective manner.
• Investigate ways to ensure patient safety in unobserved waiting areas.
• Ensure appropriate action is consistently taken in relation to medical safety alerts.
• Ensure that complaints are dealt with in a timely manner and the policy in place for complaints is followed. The practice must also ensure that information relating to complaints is readily available for patients.

In addition the provider should:

• Formalise learning from trends in significant events.
• Improve communication with patients in order to seek their feedback and act on it.
• Communicate information resulting from multi-disciplinary team (MDT) meetings in an effective manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice