Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We rated the population groups as requires improvement overall because the issues identified as requires improvement relating to patient safety, responsiveness and providing a well-led service affected all patients.

We carried out an announced comprehensive inspection at The Crossraods Surgery on 21 November 2017 as part of our inspection programme.

At this inspection we found:

• There were systems in place to manage medication safely.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• Staff were aware of their responsibilities in relation to safeguarding children and vulnerable adults however the deputy safeguarding lead was not clear about some processes.

• Recruitment records did not contain all the necessary information to demonstrate the suitability of staff.
• Policies and procedures did not provide appropriate guidance to staff.
• There were no formal arrangements in place to provide GP services to patients and support to nursing staff when the GP was not available at the practice.
• All the required safety checks of the premises had not taken place.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt supported and they had access to training and development opportunities appropriate to their roles.

• Patients said they were overall treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.
• Seven out of 30 patients who returned comment cards made comments about lack of access to a GP or not being able to see the same GP.

• Complaints were taken seriously however improvements were needed to make the process more robust.

• The systems to promote good governance and management were not sufficiently robust.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

• The distribution of patient safety alerts should be monitored to ensure all clinicians receive them.

• The significant event policy should include examples of what constitutes such an event.

• Cleaning schedules should be put in place, checks of cleaning standards should be documented and a recorded action plan put in place to show how the actions from the external infection control audit are to be met.
• A system to enable safety checks of the premises to be undertaken at the required frequencies should be put in place.
• The deputy safeguarding lead should familiarise themselves with all processes relating to adult and child safeguarding so that they can operate them effectively in the absence of the designated lead.

• Written information about the role and remit of the advanced nurse practitioner should be publicised so that patients can make an informed choice about which clinician they request an appointment with.

• A copy of the non-medical prescribers declaration that has been signed by the provider should be held at the practice.

• The practice website should contain further information for patients to refer to such as relevant policies and procedures, information about health conditions and support organisations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice