Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. (This is the first inspection).

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Not rated

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Not rated

People experiencing poor mental health (including people with dementia) – Requires improvement

We carried out an announced comprehensive inspection at The University of Lincoln Health Centre on 14 February 2018. This inspection was carried out as part of our inspection programme.

At this inspection we found:

• Clinical leadership and governance systems needed to be strengthened. Some staff did not feel able to raise concerns and there was a disconnect between the leadership team and staff.
• There was a system for recording and acting on significant events and incidents but this needed to be reviewed. Some significant events were not discussed at meetings and the process for reporting, discussing, recording and learning from significant events, including reviewing themes and trends was not always effective.
• The practice did not have an effective system in place to gain the assurances required that nurse-led services were of sufficient quality.
• Patients said they were treated with dignity, respect and compassion and they were involved in their care and decisions about their treatment.
• We saw evidence pathology results were not reviewed and actioned every day.
• Information about how to complain was not clearly displayed in the reception area or available on the practice website. Patients told us they did not know how to complain. On the day of the inspection, the practice amended the leaflet title to include the wording ‘How to Complain’. Complaints were not discussed at practice meetings in sufficient detail to learn from them or to consider trend analysis.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• We saw evidence the practice actively sought patient feedback and the practice had made improvements to patient access.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

More detail can be found in the Requirement Notices section at the end of this report.

The areas where the provider should make improvements are:

• Review the newly implemented system for monitoring prescriptions through the practice to ensure it is embedded.
• Review the emergency drugs ordering system so the practice has sufficient stock of emergency drugs.
• Review risk assessments to ensure the practice retains oversight and that all risk assessments are up to date.
• Review the training system so practice staff are up to date with mandatory training.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice