Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection at The Lime Tree Surgery on 6 October 2017 in response to concerns raised directly with CQC. This related to patient access to services, quality of treatment, appropriate standards of cleanliness and hygiene and confidentiality of patient identifiable information. This report covers our findings in relation to the inspection on 6 October 2017. As a result of this inspection the provider’s rating remains unchanged and stays as Good.

Our key findings were as follows:

• The practice had experienced a period of change following a recent merger.

• We found the premises to be clean, tidy and in generally good repair both inside and out.

• Staff demonstrated an understanding of the importance of patient confidentiality.

• We found that the practice had taken positive steps to improve access to appointments and patients and staff told us access to appointments had improved.

• Although lessons were learned from individual concerns and complaints, there was not sufficient communication about complaint outcomes between the practice management team.

However, there was one area of practice where the provider should make improvements.

The provider should:

• Improve communication in relation to complaint outcomes between the practice management team and clinical staff.

• Consider including the nursing team in clinical meetings, significant events meetings and complaints meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

When we carried out an announced comprehensive inspection of this practice on 4 February 2016 we found breaches of legal requirements in relation to safety and for being well-led. Overall the practice was rated as requires improvement.

When undertook a focused follow up inspection on 11 October 2016 we found that not all of the previous identified breaches of regulations had been adequately addressed. They were rated as requires improvement for the provision of safe services and rated as good for the provision of well-led services. Overall the practice was rated as good.

The full comprehensive report on the February 2016 inspection and the focused follow up report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Lime Tree Surgery on our website at www.cqc.org.uk.

The inspection covered in this report was an announced focused inspection. It was undertaken on 26 May 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 11 October 2016.

The practice is now rated as good for the provision of safe services and continues to be rated as good overall.

Our key findings were as follows:

• All staff had received adult and children safeguarding training at a level appropriate to their role.

• All clinical staff had received training in the Mental Capacity Act 2005 (MCA).

• The staff we spoke to demonstrated knowledge of safeguarding and the MCA appropriate to their role. 

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 of this practice on 4 February 2016. Breaches of legal requirements were found in relation to safety and for being well-led. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements. We undertook this focused inspection on 11 October 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. The full comprehensive report on the 4 February 2016 inspection can be found by selecting the ‘all reports’ link for The Lime Tree Surgery on our website at www.cqc.org.uk.

Our previous report highlighted the following areas where the practice must improve:

• Continue to improve records of training, including that nurses are trained to level two for child safeguarding.
• Continue to improve records of staff appraisals to ensure they are completed annually for all staff.
• Ensure that all Patient Specific Directions are recorded and completed correctly, in line with legislation.
• Ensure fire extinguishers and oxygen tanks are fit for use and appropriately serviced.
• Display appropriate warning signage on treatment room doors where oxygen is stored.
• Ensure there are arrangements for all staff to attend formal meetings, including discussion of significant events in a timely manner, and improve communication at all levels.

This inspection was an announced focused inspection carried out on 11 October 2016 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 4 February 2016. We found that not all of the requirements had been met.

Our key findings across the areas we inspected for this focused inspection were as follows:-

• The practice had implemented a system to monitor and maintain an overview of all training and staff appraisals. However we noted that not all staff had completed safeguarding and Mental Capacity Act 2005 training to a level appropriate to their role.
• We saw evidence that Patient Specific Directions were recorded and completed correctly, in line with legislation.
• We saw that fire extinguishers and oxygen tanks had been appropriately serviced.
• There were appropriate warning signs in areas where oxygen was stored.
• We saw evidence that staff attended formal meetings, which included discussion of significant events.

There was still an area of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that all clinical staff undertake appropriate training to the required level for safeguarding vulnerable adults and children. As well as undertake training for the Mental Capacity Act 2005

At our previous inspection on 4 February 2016, we rated the practice as requires improvement for providing safe services as not all clinical staff had received training for safeguarding children or vulnerable adults. At this inspection, we found that some training for staff was still missing. Consequently, the practice is still rated as requires improvement for providing safe services.

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 Lime Tree Surgery on 4 February 2016. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, significant events were not always discussed in a timely manner and learning from such events was not shared with all staff.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had 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.
• Patients said urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Continue to improve records of training, including that nurses are trained to level two child safeguarding.

• Continue to improve records of staff appraisals to ensure they are completed annually for all staff.

• Ensure that all Patient Specific Directions are recorded and completed correctly, in line with legislation.

• Ensure fire extinguishers and oxygen tanks are fit for use and appropriately serviced.

• Display appropriate warning signage on treatment room doors where oxygen is stored.

• Ensure there are arrangements for all staff to attend formal meetings, including discussion of significant events in a timely manner, and improve communication at all levels.

In addition the provider should:

• Review the arrangement of health and wellbeing publications provision within waiting rooms, considering patients’ confidentiality and privacy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice