Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Parkview Surgery on 16 June 2016. The overall rating for the practice was good. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Parkview Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 July 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 16 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

At the inspection on 16 June 2016, the practice was rated overall as ‘good’. However, within the key question safe, areas were identified as ‘requires improvement’, as the practice was not meeting the legislation around ensuring adequate arrangements were in place to ensure care and treatment to patients was provided in a safe way in relation to: medicines management; the provision of medical equipment; and in ensuring patients were fully protected against the risks associated with the recruitment of staff. There were deficiencies in the stocking of emergency medicines and prescription security; in ensuring clinical items and equipment were up to date; and in the recording of recruitment information, in particular in ensuring the documentation of appropriate pre-employment checks. The practice was issued requirement notices under Regulation 12, Safe care and treatment, and under Regulation 19, Fit and proper persons employed.

Other areas identified where the practice was advised they should make improvements with the key question of safe included:

• Ensure all staff are aware of the practice specific policy on safeguarding of vulnerable adults.
• Ensure the completion of action already initiated of Disclosure and Barring Scheme (DBS) checks for staff who carry out chaperoning duties, or risk assess the need and put in place mitigating arrangements.
• Carry out and record monthly water temperature checks, identified as necessary as a result of the latest legionella risk assessment of the practice.
• Review vaccine cold storage processes to ensure they conform to Public Health England guidance regarding packaging.
• Arrange for regular fire evacuation drills to be completed and documented.

At our July 2017 inspection we reviewed the practice’s action plan submitted in response to our previous inspection and a range of supporting documents which demonstrated they are now meeting the requirements of Regulation 12, Safe care and treatment, and Regulation 19, Fit and proper persons employed, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice also demonstrated improvement in the other areas identified in the report from June 2016 which did not affect ratings. These improvements have been documented in the safe section, showing how the registered person has demonstrated continuous improvement since the full inspection.

Areas identified at the June 2016 inspection where the practice was advised they should make improvements within other key questions of effective and caring included:

• Put in place a documented induction programme for all staff to monitor progress and record the completion of the induction process; and
• Review the system for the identification of carers to ensure all carers have been identified and provided with support.

At our July 2017 inspection we found there was now a documented induction programme in place and, in relation to recently recruited staff, a record of their completion of the induction process was on their personnel files.

Since the previous inspection the practice had taken further action to proactively identify and support carers. The practice had identified now identified 155 patients as carers (just above 2.5% of the practice list).

However, there were also areas of practice where the provider needs to make improvements. In particular the provider should:

• Ensure the policy for reporting when vaccination fridge temperatures varied from the allowable range was strictly adhered to in all cases.
• Dispose of out of date medical items when new items are purchased to replace them.

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 Parkview Surgery on 16 June 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 and an effective system in place for reporting and recording significant events.
• Risks to patients who used services were assessed and managed. However, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. There were some deficiencies in particular in medicines management, the disposal of out of date equipment and in the practice’s recruitment processes.
• 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 in most respects. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients said they were able to make an appointment with a named GP when they needed one and there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and equipment to treat patients and meet their needs but building work was underway to improve patient facilities.
• 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 had systems in place to ensure compliance with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Complete and record a risk assessment of the practice’s decision not to stock medicine excluded from the emergency medicines kit. Ensure a record of prescription pads batch numbers is kept to maintain prescription security.
• Ensure all equipment used for providing care or treatment is up to date and safe for such use.
• Ensure patients are fully protected against the risks associated with the recruitment of staff, in particular in the recording of recruitment information and in ensuring all appropriate pre-employment checks are carried out and recorded prior to a staff member taking up post.

In addition, the areas where the provider should make improvements are:

• Ensure all staff are aware of the practice specific policy on safeguarding of vulnerable adults.

• Ensure the completion of action already initiated of Disclosure and Barring Scheme (DBS) checks for staff who carry out chaperoning duties or risk assess the need and put in place mitigating arrangements.
• Carry out and record monthly water temperature checks, identified as necessary as a result of the latest legionella risk assessment of the practice.
• Review vaccine cold storage processes to ensure they conform to Public Health England guidance regarding packaging.
• Arrange for regular fire evacuation drills to be completed and documented.
• Put in place a documented induction programme for all staff to monitor progress and record the completion of the induction process.
• Review the system for the identification of carers to ensure all carers have been identified and provided with support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice