We had previously carried out an announced comprehensive inspection at Swineshead Medical Group on 12 February 2019.

At that inspection we rated the practice as inadequate in safe, requires improvement in effective and well led and good in caring and responsive. The practice was rated as requires improvement overall.

At that inspection we found;

• There was no assurance that the prescribing of medicines to some patients kept them safe.
• There were no records kept of dispensing errors and near-misses.
• The practice was not assured of the competence of their dispensary staff as no annual competency checks had been carried out’
• Dispensary standard operation procedures had not been signed by dispensers.
• Blank prescription stationary was not monitored effectively or stored securely.
• Equipment that may be needed in a medical emergency was not checked frequently enough to assure its efficacy.
• The temperature of some fridges used to store medicines were not recorded at least daily.
• Not all staff had not completed the practices mandatory training.
• There had been no audit of surgical procedures carried out at the practice

Because of our findings we served the practice with Warning Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The full comprehensive report on the February 2019 inspection can be found by selecting the ‘all reports’ link for Swineshead Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 April 2019 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 12 February 2019. This report covers our findings in relation to those requirements.

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Our key findings were as follows:

• The practice has reviewed and revised its process for ensuring that prescribing was safe.
• A log had been introduced for dispensary errors and near-misses.
• Dispensers competencies had been assessed and completed.
• Dispensary standing operating procedures had all been signed by dispensers.
• Blank prescription stationary was secured.
• There was frequent checking of equipment intended for use in a clinical emergency.
• Fridge temperatures were recorded daily.
• Staff training for the providers essential training was at 100% compliance.
• A system of audit and control had been implemented to provide assurance of surgical procedures.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Swineshead Medical Group on 12 February 2019. This was as part of our inspection program.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

This practice is rated as requires improvement overall. (At our previous inspection on 28 July 2015 we rated the practice as good)

We rated all the population groups as requires improvement as the areas of concern affected all of the population groups.

We rated the practice as inadequate for providing safe services because:

• There was no assurance that the prescribing of medicines to some patients kept them safe.
• The process intended to safeguard children was not effective.
• The system for learning from serious adverse events was not effective.
• There were no records kept of dispensing errors and near-misses.
• The practice was not assured of the competence of their dispensary staff as no annual competency checks had been carried out’
• Dispensary standard operation procedures had not been signed by dispensers.
• Blank prescription stationary was not monitored effectively or stored securely.
• There was a back-log of 191 sets of new patient notes that had not been summarised.
• Equipment that may be needed in a medical emergency was not checked frequently enough to assure its efficacy.
• The temperature of some fridges used to store medicines were not recorded at least daily.

We rated the practice as requires improvement for providing effective services because:

• Not all staff had not completed the practices mandatory training.
• There had been no audit of surgical procedures carried out at the practice

We rated the practice as good for providing caring services.

We rated the practice as good for providing a responsive service.

We rated the practice as requires improvement for providing well-led services because:

• There were not effective systems to support good governance and management.
• The practice did not always have clear and effective processes for managing risks.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Swineshead Medical Group on 28 July 2015. Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe and well-led services.

We had previously inspected this practice in October 2014 when we found that the practice required improvement in providing safe and well led services.

Our key findings across the areas we inspected at this inspection were as follows:

• Staff had received training regarding the Mental Capacity Act and demonstrated a good knowledge of the key provisions affecting General Practice.
• The practice had a clear process to ensure clinicians professional registrations were checked on a regular basis.
• There was a clear meeting structure with multi-disciplinary, clinical , practice and partner meetings on regular basis.
• There was a process for the management of safety alerts such as those disseminated by the Medicines and Healthcare products Regulatory Agency
• The practice had a system in place to audit and evidence that all cleaning had been carried out on a regular basis. There were effective infection prevention and control procedures in place.
• The practice had systems in place to monitor and improve quality and identify risk
• The practice provided supervision and mentorship to the nurses to help ensure that care and treatment provided was safe and effective.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Swineshead Medical Practice provides primary medical services to approximately 8,500 patients and is situated in purpose built premises. The practice has a large catchment area which covers Swineshead, Donington and Bicker. Its boundaries extend from the outer edges of Boston and as far as Gosberton, Pinchbeck and Heckington in Lincolnshire.

We carried out an announced comprehensive inspection on 6 October 2014. The inspection focussed on whether the care and treatment of patients was safe, effective, caring, responsive and well led.

The practice demonstrated that it understood the local patient population and provided flexible and responsive services to meet patients’ needs. Patients told us they felt safe, the staff were kind, caring and respectful, and went onto to say they felt the practice was well led.

We found that the practice was responsive to the needs of older people, people with long term conditions, families, children and young people, the working age population (and those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

Patients were complimentary about the service they received.

Some systems were in place to ensure that patients were safe, this included safeguarding policies and procedures that were understood and acted upon by staff.

There was an open culture within the practice and staff felt they were able to raise and discuss any issues with the practice manager or the GP partners.

There was evidence of completed audit cycles undertaken to ensure patients’ care and treatment was effective and which resulted in improvement to the quality of the service the practice provided.

The practice had suitable arrangements in place to respond to patients with a variety of health needs.

Leadership roles and responsibilities were well established with clear lines of accountability.

The overall rating for Swineshead Medical Group is ‘requires improvement’.

We found the practice to be good in the effective, caring and responsive domains and requires improvement in the safe and well-led domains.

There were areas of practice where Swineshead Medical Group need to make improvements.

We have asked the practice to take action on four issues where we found that improvements were needed.

The provider was in breach of regulations related to:

• Cleanliness and Infection control
• Assessing and monitoring the quality of service provision

Importantly, the provider must:

Have good infection prevention and control systems to ensure that patients who use the services receive safe and effective care. The practice must have a system in place to audit and evidence that all cleaning had been carried out on a regular basis and all the areas are clean and hygienic.

The practice must have systems in place to monitor and improve quality and identify risk

The practice must provide supervision and mentorship to the nurse practitioner/nurse prescriber to ensure that care and treatment provided is safe and effective.

The practice must havea policy for the management ofsafety alerts such as those disseminated by the Medicines and Healthcare products Regulatory Agency (MHRA). MHRA alerts are sent where there are concerns over the quality of the medication or equipment. This could affect the patient in terms of the safety or effectiveness of the medication or equipment. New guidelines for best practice, the implications for the practices performance and patients discussed.

In addition the provider should:

Offer patients with learning disabilities the opportunity to have an annual physical health check.

Copies of patient participation group (PPG) minutes should be displayed in the reception area and on the practice website so that they can be accessed by all patients, staff and the public.

All staff receive training to have an awareness of the Mental Capacity Act 2005.

The practice should have a Standard Operating Procedure for medicine recalls. A Standard Operating Procedure (SOP) is a document consisting of step-by-step information on how to execute a task. Recalls protect a patient especially when the product has been widely distributed.

The practice should have a policy in place to protect the public and ensure that nurses and doctors are registered in accordance with the requirements of the Nursing and Midwifery Council (NMC) and General Medical Council (GMC).

The practice should have full team practice meetings which are regular, structured and relevant to give all staff the opportunity to take part in order for performance, quality and risks to be discussed.

Demonstrate that staff have read and understood all the policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

We spoke with 10 people who received their primary medical care from the practice, one doctor and administrative and dispensary staff.

People told us they were happy with the service they received. One person said, “I have no complaints whatsoever, they have always treated me well.” Another person said, “We are fortunate to have this service here. We always have a good experience of the services here."

People told us they were able to see a doctor or nurse of their choice; however they often had to wait for a week or two to be able to do so.

People were confident in the treatment they received. One person told us, “I have a heart condition and my experience of treatment here is good.”

When people required an urgent appointment they were either seen or had a telephone consultation on the day they requested the appointment. One person said, “The booking system is good, flexible. They prioritised my daughter when she was unwell."

We saw systems ensured people received their medication when needed. One person said, “The dispensary is good and my medicine is always ready to collect.” Medication was safely obtained, stored and disposed of.

Staff received appropriate training which supported them to provide a safe service to people.

The provider took account of complaints comments and the patient participation group to improve the services they offered to people.