Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ardleigh Surgery on 1 November 2016 where the practice was rated as good overall. However the practice was found to be requires improvement for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for The Ardleigh Surgery on our website at www.cqc.org.uk.

This announced desk based review was carried on 10 August 2017 to confirm that the practice had made the improvements required that were identified in our previous inspection on 1 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is rated as good for providing safe services.

Our key findings were as follows:

• The practice was recording and learning from near misses when dispensing. These had been discussed at a practice meeting.

• The practice had a new process to ensure prescriptions and medicines waiting to be collected were securely stored.

• There was an effective checking process in place to meet the ‘cold chain procedure’ requirements for the storage of medicines.

• The practice had appropriately authorised ‘Patient Specific Directions’ (PSDs) which were signed prior to the administration of vaccinations by the assistant Practitioner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at The Ardleigh Surgery on 01 November 2016. Overall the practice is rated as good.

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

• Staff members knew how to raise concerns, and report safety incidents. Safety information was appropriately recorded and lessons learned were identified and shared with staff members.
• Risks to patients and staff members were assessed, documented and acted on appropriately.
• The dispensary policies and procedures were appropriate to keep people safe however near misses were not being recorded.
• Patient care and treatment was planned using current clinical guidance.
• Some ‘Patient Group Directions’ that were guidance for the administering of vaccinations were out of date, these were reviewed and updated immediately.
• The ‘Patient Specific Directions’ that were guidance used by the assistant practitioner for specific patients were not always appropriately authorised prior to administering vaccinations. However this issue was addressed immediately on the day of inspection.
• Patient comments were positive about the practice and the services provided.
• The temperature of the fridge in use for the storage of medicines was not being monitored effectively.
• Information regarding how to complain was available at the practice and on their website.
• Patients told us there were urgent appointments available on the day they requested.
• The practice had appropriate facilities and equipment to treat patients and meet their health and treatment needs.
• The practice patient participation group (PPG) told us about their involvement with practice development.
• Staff members said they were supported in their working roles by both the practice manager and the GPs.
• The leadership structure was clear and staff felt supported by management.
• There were continuous improvements seen at all levels at the practice.
• The areas where the provider should make improvements are:
• Record and learn from near misses when dispensing, to allow assessment of risk when dispensing.
• Maintain the new process to ensure prescriptions and medicines waiting to be collected are securely stored.
• Maintain effective checking processes are in place to meet the ‘cold chain procedure’ requirements for the storage of medicines.
• Ensure that appropriately authorised ‘Patient Specific Directions’ (PSDs) are signed prior to the administration of vaccinations by the assistant practitioner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We conducted this inspection to follow up on compliance actions following our last inspection on 20 September 2013 when we found concerns with regards to the provider’s management of medicines.

During our inspection on 20 September 2013 we found that there were inconsistencies in the accounting of controlled drugs and a lack of effective audit systems in place for the checking of medicines stored within GP’s bags.

During our inspection on 10 December 2013 we found that improvements had been made. We were told by the lead dispenser that action had been taken to implement a procedure that the GPs no longer carried controlled drugs routinely in their bags.

We saw that there was a procedure in place for the dispensing of controlled drugs to GPs. There were appropriate arrangements in place to manage the risks associated with the accounting of controlled drugs.

We were shown the monthly audit record for medicines in GPs bags. We saw that the records for October, November and December 2013 had been signed by the GPs. There was an effective process in place for checking the medicines in GPs bags.

We saw that people were asked for their consent before any care or treatments were provided. One person said, “They always explain what needs to be done, how it will be done and why. They always ask my permission before they do something. The GPs and nurses are very courteous.”

We saw that people were kept well informed of the services available in the surgery. One person told us, “My health would be worse if I did not have that surgery. They really care. I feel safe and secure with the service that I get.” We saw evidence that care and treatment were planned and delivered in a way to meet the needs of people who used the service.

The surgery did not have appropriate arrangements in place to manage the risks associated with stock control of controlled drug medicines. There were no effective audit processes in place for checking the medicines in GP's bags. This meant that people were at risk of receiving out of date medicines.

We spoke with four people who gave positive comments about how their care and treatment was delivered. One person we spoke with said, “I felt empowered after seeing my GP. They had given me everything I needed to manage my pain myself.”

We saw that the surgery had a complaints process in place and that complaints people made were responded to appropriately. We saw that clinical meetings were held every two weeks and saw evidence that learning from significant events, audits and complaints were shared with staff at the surgery.