Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery – Barretts Grove on 11 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report published in December 2016 can be found by selecting the ‘all reports’ link for The Surgery – Barretts Grove on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 13 June 2017, carried out to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 11 November 2016. There were breaches in health and safety, risk management and recruitment processes. There were also concerns with policies and procedures, staff training and the business continuity plan. 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:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The practice had a full complement of emergency medicines, all of these were stored correctly including vaccines, were in date and included a supply of oxygen.
• The practice had completed a number of risk assessments, which included fire, legionella and infection control.
• All electrical equipment was tested to make sure it was in good working order and clinical equipment was calibrated.
• There was a comprehensive business plan and we saw an example of when it had been effectively used.
• All policies and protocols were accessible to all staff members and had recently been reviewed and version controlled.
• The practice had a new recruitment process, we saw that this was followed for all newly appointed staff members and included an induction.
• All staff had completed mandatory training such as basic life support and fire safety and all clinical staff had attended training updates.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients rated the practice in-line with the CCG and national averages for several aspects of care.
• 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.
• 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.

However, there was also an area of practice where the provider needs to make improvements.

The provider should:

• Continue to work to improve coding issues for patients with mental health as identified by QOF.

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 Surgery – Barretts Grove on 11 November 2016. Overall the practice is rated as requires improvement. Our key findings across all the areas we inspected were as follows:

• There was no emergency use oxygen or first aid kit for the event of a medical emergency and there were multiple out of date items in treatment rooms such as swabs, needles and syringes.
• The practice had a number of policies and procedures to govern activity, but there was no system to review policies and some arrangements were absent, incomplete or had not been implemented such as legionella, fire safety, health and safety and control of substances hazardous to health (COSHH).
• The practice had not carried out safety testing of any electrical equipment. Most items had been calibrated but a medicines refrigerator check was overdue.
• Infection control arrangements were unclear and not comprehensive. There was no evidence of clinical equipment cleaning and a children’s play facility and chairs were visibly dirty.
• Some medicines were in unsecured medicines refrigerators in an unmarked staff only area; and Patient Group Directions (PGDs) had not been signed by the authorising prescriber to allow nurses to administer injectable medicines in line with legislation.
• Patients were safeguarded from abuse but there were weaknesses in systems for accident/ incident reporting and recording and following up safety alerts.
• The provider was aware of and complied with the requirements of the duty of candour.
• Data showed patient outcomes were comparable to the national average and staff assessed needs and delivered care in line with current evidence based guidance.
• 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 undergoing improvement building and refurbishment works and had interim facilities to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Establish effective systems for managing risks to patient’s safety including premises and equipment, safety alerts, out of date items, legionella, medicines and equipment and in the event of a medical emergency.
• Ensure implementation of the recruitment policy and appropriate induction and training for all staff.
• Establish effective systems and processes including reviewing and updating procedures and guidance.

In addition the provider should:

• Review the business continuity plan.
• Improve arrangements for deaf or hard of hearing patients.
• Ensure completion of premises improvements and arrangements for patient’s privacy in the reception area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice