Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Hollies Surgery, on 13 April 2016. The overall rating for the practice was ‘Good’. The practice were found to be requiring improvement in one area, covered by the key question of ‘Safe’ The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for The Hollies on our website at www.cqc.org.uk.

This inspection was an announced focused follow-up inspection carried out on 1 February 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 13 April 2016. This report covers our findings in relation to those requirements.

Overall the practice is now rated as Good

Our key findings were as follows:

• All significant events are formally reported, recorded, investigated and findings shared with all staff, including clinicians who may not be working at the practice any more, but who were working at the practice at the time of an incident.

• Formal patient specific directions are now in place. These cover medicines administered by nurses and health care assistants, that are not covered by patient group directions, for example, Vitamin B injections.

• A system for dealing with information requests from multi-agency safeguarding hubs and child protection teams has been put in place. We saw that staff were aware of this system and how it should be used by the practice.

• Staff recruitment checks were in place and copies of these checks were held by the practice.

In addition the provider should:

• Progress the correct registration of the partnership with CQC, including removal of those partners who no longer work at the practice.

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 The Hollies on 13 April 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. A system was in place for reporting and recording significant events. However, we found a number of incidents had not been recorded, reported and investigated. In some cases, findings were not shared with staff that had left the practice, which limited the learning from events.
• Overall, risks to patients were assessed and managed. However, we found arrangements for the administration of some treatments had not been formalised, for example, with patient specific directions.
• Safeguarding processes were in place and followed by staff. We did find that some requests for reports by safeguarding review boards were not met.
• Some recruitment checks had not been carried out.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 there was continuity of care, with urgent appointments available the same day.
• The practice was equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The partnership was undergoing a period of change which the lead partner and practice manager were managing.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider MUST make improvements are:

• To ensure that all significant events are recorded, reported and investigated. Learning should be shared with all staff involved in the incident.

• To produce patient specific directions to cover administration of medicines by health care assistants and to ensure these are signed by GPs and healthcare assistants.
• To ensure that all staff recruitment records required by Schedule 3 are held by the practice.
• To ensure that the practice registration with the Care Quality Commission (CQC) is accurate and correctly names all partners involved in the delivery of regulated activities.
• To ensure that all requests for safeguarding reports are met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice