Letter from the Chief Inspector of General Practice

We carried out a focussed inspection at The Phoenix Practice on 2 August 2017. We found the practice to be good for providing safe services and it is rated as good overall.

We previously conducted an announced comprehensive inspection of the practice on 15 June 2017. As a result of our findings, the practice was rated as requires improvement for providing safe services and rated as good for providing effective, responsive, caring and well led services, which resulted in an overall rating of good. At that time, we found that the provider had breached Regulation 12 (1) (Safe care and treatment) of the Health and Social Care Act 2008 due to concerns regarding the safe prescribing and monitoring of high risk medicines.

The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements. We undertook this focussed, follow up inspection to check that the practice had followed their plan and to confirm that they had met the legal requirements.

This report only covers our findings in relation to those areas where requirements had not been met. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Phoenix Practice on our website at www.cqc.org.uk/location/ 1-551197997.

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

• The practice had taken action to ensure that the systems, processes and practices for prescribing and monitoring high risk medicines were appropriate to keep people safe.

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 Phoenix Practice on 29 September 2015. During the inspection we identified a lack of infection prevention and control (IPC) audits, IPC staff training and periodic legionella risk assessments. (The full comprehensive report on the September 2015 inspection can be found by selecting the ‘all reports’ link for the Phoenix Practice on our website at www.cqc.org.uk).

The practice was rated as requires improvement for providing safe services and was rated as good for providing effective, caring, responsive and well led services. Overall the practice was rated as good.

An announced comprehensive inspection was undertaken on 1 June 2017 at which time we were able to confirm that the IPC concerns had been addressed. However, we also identified new concerns regarding the safe prescribing and monitoring of high risk medicines. The Phoenix Practice’s individual and overall ratings therefore remain the same.

Our key findings were as follows:

• Action had been taken to improve IPC systems. For example, staff training and assessments had taken place and a programme of audits had been introduced. A legionella risk assessment had also taken place.

• The practice had clearly defined systems in place to minimise risks to patient safety, with the exception of systems in place for safely prescribing and monitoring high risk medicines called Methotrexate and Warfarin. (Immediately after our inspection we were sent confirming evidence that action had been taken to ensure that the systems, processes and practices for prescribing high risk medicines were appropriate to keep people safe).

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.

• 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.
• 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.
• 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 area where the provider must make improvement is:

• Continue to monitor systems introduced in relation to monitoring and prescribing high risk medicines.

The areas where the provider should make improvement are:

• Continue to monitor cervical screening uptake and take action as necessary to improve performance.

• Undertake a risk assessment of the practice decision to provide a baby changing table as opposed to a wall mounted unit; and also consider relocating baby changing facilities away from patient waiting areas, so as to improve patients’ privacy and dignity.

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 Phoenix Practice on 29 September 2015. Overall the practice is rated as good.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to medication checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received some training appropriate to their roles and any further training needs had been identified and planned with the exception of infection control.

• 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 they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments 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.

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

Importantly the provider must;

• Ensure the infection control leads receive training in infection control and prevention and annual infection control audits are undertaken so as to identify and act on infection control risks.
• Ensure that a Legionella risk assessment is undertaken.

Importantly the provider should;

• Ensure safe systems for the management and auditing of emergency medications and equipment.

• Ensure that prescription serial numbers are logged to monitor their use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice