Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Park Surgery on 19 August 2016. We visited the main surgery in Driffield and the branch surgery at Nafferton during the inspection. The practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However dispensary staff were not clear about reporting incidents, near misses and concerns, medicines related incidents were not always reported and investigated.

• Risks to patients were assessed and well managed with the exception of those relating to the management of medicines.

• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to get same day appointments and pre-bookable appointments were available.
• 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 a number of policies and procedures to govern activity and systems to monitor quality improvement however these were not fully implemented.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure medicines are managed and dispensed safely and in accordance with the practice policy and procedures. Implement processes to ensure acute prescriptions were signed within a reasonable timeframe and the standard operating procedure for uncollected prescriptions was followed. Ensure action was taken and recorded in response to refrigerator temperatures in the dispensary being outside of the recommended range for storing medicines. Implement a process to ensure prescription pads for use by individual GPs were tracked through the practice in accordance with national guidelines.

• Ensure quality monitoring systems are implemented.

Importantly the provider should:

• Share lessons learned from incidents with all staff in the practice.

• Keep records of controlled drugs in accordance with the relevant legislation

• Review the telephone appointment system to improve patient satisfaction with accessing the practice by telephone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with staff in the main pharmacy and the practice manager and saw that they dispensed medication in a well organised and safe way.

In November 2013 we carried out an inspection of this service. We judged, at that time, that improvements were needed to the way complaints and medicines were managed. The provider sent us an action plan telling us how they would address the issues identified.

At this inspection, we found improvements had been made and the issues previously identified had been addressed. However we identified other areas of concern relating to the way medicines were managed.

We found systems were now in place for appropriately managing, reviewing and learning from complaints. Two patients told us they had not needed to make a complaint but were confident if they did that it would be looked into.

We also found the previous issues relating to medicine management had been addressed. Two people who we spoke with were happy with the care they received and the way their medicines were managed. One person who was eligible for surgery dispensing told us that they were given the choice of having their medicines dispensed at the surgery or at their local pharmacy at their registration appointment. Despite the improvements, we identified other areas of concern regarding the way medicines were managed. We have asked the provider to address these issues.

We carried out a follow up inspection in November 2013 following a previous inspection in July 2013 where issues were identified with quality assurance systems at The Park Surgery. The provider submitted an action plan following the inspection in July 2013 stating that they were going to address all the areas highlighted in the report. We visited again in November 2013 to see if they had carried out these actions.

We found that there were issues with medication audits and error recording. There was a complaints system in place but this was not being executed effectively. There had been some areas addressed regarding monitoring and quality assurance but there was still some issues with ongoing quality assurance.

During our inspection we visited the Park Surgery and Nafferton branch site.

We saw that steps had been taken to encourage patient feedback by circulating a patient questionnaire and that the results of this had been published on the practice website.

We spoke with two doctors and the practice manager who were able to explain how they would escalate any concerns relating to safeguarding and the in-house process for identifying minor concerns on the clinical system.

We saw that there were issues with the systems for monitoring the auditing processes currently in place at the Nafferton site. This included medication and emergency equipment contained within the emergency drugs kit being out of date, despite being checked by the practice nurse on a weekly basis.

We spoke with five patients who were pleased with the service they received from the practice. Comments included:

“Reception staff very helpful and polite. They know us all and if we are feeling unwell they are very sympathetic.”

“I trust the doctor implicitly.”

“Never had any concerns about the treatment on offer.”

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Park Surgery on 19 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 19 August 2016 inspection can be found by selecting the ‘all reports’ link for The Park Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following actions by the provider and was an announced comprehensive follow up inspection on 25 April 2017. We visited the main surgery in Driffield and the branch surgery at Nafferton during the inspection. Overall the practice is now rated as good

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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. However some patients told us it could be difficult to get through on the phone and to make appointments in advance.
• 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 the requirements of the Duty of Candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Review procedures to ensure fridge temperatures are recorded daily in line with national guidance.

• Implement a standard operating procedure for dispensers for when there is no GP on site at the branch surgery.

• Embed documented checks of competency for dispensary staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice