Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Twickenham Park Surgery on 20 September 2016. The practice was rated as good overall. A breach of legal requirements was found relating to the Safe domain. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that the necessary documentation was in place for the administering of medicines. We also identified areas where improvements should be made, which included advertising the availability of chaperones and language translation, ensuring that staff have received appropriate training in line with the practice’s chaperone policy, ensuring that their recruitment policy is up to date, reviewing the arrangements for storing emergency medicines, reviewing their arrangements for distributing medicines updates to staff, ensuring that complete records are kept relating to complaints, and reviewing the way that significant events are investigated and the learning form them is shared and embedded.

We undertook this focussed desk-based inspection on 9 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Twickenham Park Surgery on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe services. Following the follow-up inspection, they are rated as good overall.

Our key findings were as follows:

• The practice had the correct documentation in place to allow staff to administer medicines, and we saw evidence that the practice had ensured that all staff were aware of the process and their responsibilities in relation to this.
• The practice advertised the availability of language translation services in the waiting area.
• The practice ensured that all staff who acted as chaperones were trained for the role, and they advertised this service to patients in the waiting area.
• The practice’s recruitment policy had been updated to accurately reflect the practice’s approach to carrying-out Disclosure and Barring Service (DBS) checks on staff.
• The practice held stocks of emergency medicines and these were stored in an area of the practice which was secure but easily accessible to staff in an emergency.
• The practice had an effective system in place for distributing medicines updates to relevant staff and kept a record of the action that they had taken in response to these alerts.
• We saw evidence that the practice kept detailed records of significant events, and that action was taken to share and embed learning resulting from incidents.
• The practice kept complete records relating to complaints received, including records of action taken to share learning resulting from complaints with staff. However, we noted that the practice did not always include contact details for the Parliamentary and Health Service Ombudsman in their complaint responses.

One area where the provider should make improvement is:

• They should ensure that they provide contact details for the Parliamentary and Health Service Ombudsman in their complaint responses so that patients can continue to pursue their complaint if they are unhappy with the practice’s response.

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 Twickenham Park Surgery on 20 September 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 a system in place for reporting and recording significant events; however, in some instances the member of staff involved in the incident was not fully involved in the investigation. There was also a lack of evidence in some cases of lessons learned from significant events being shared.
• Risks to patients were assessed and well managed, with the exception of those relating to the administration of medicines; the practice did not have a clear system to ensure that the correct documentation was in place to allow staff to administer medicines, and the documentation that we viewed did not contain sufficient detail to ensure that medicines were safely administered.
• 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.
• Processes were in place to ensure that staff received medicines updates and safety alerts; however, the assessment of whether these alerts related to general practice and needed to be sent to staff was made by a junior member of staff; and therefore, there was a risk that relevant information could be inadvertently overlooked.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patients could request a chaperone, and language translation services were available; however, these were not advertised in the waiting area.
• 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; however, the practice did not record verbal complaints.
• 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 had good facilities and was well equipped to treat patients and meet their needs. Emergency equipment and medicines were available; however, these could be difficult to access quickly in an emergency.
• The practice had an overarching governance framework which supported the delivery of good quality care. Practice specific policies were implemented, with the exception of those relating to pre-recruitment checks and training for staff who acted as chaperones.
• 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 areas where the provider must make improvement are:

• They must ensure that the correct legal documentation is in place to allow staff to administer medicines, and that all relevant staff are aware of the process and their responsibilities in relation to this.

In addition, the provider should make improvement in the following areas:

• They should consider putting information in the waiting area about the availability of chaperones and interpreters.
• They should ensure that staff acting as chaperones have received appropriate training, in line with their chaperone policy.
• They should review their recruitment policy to ensure that it accurately reflects the practice’s decision regarding the requirement for staff to receive Disclosure and Barring Service (DBS) checks.
• They should review the storage arrangements for their emergency medicines to ensure that they can be quickly accessed in an emergency.
• They should review their system for distributing medicines updates to ensure that it is robust.
• They should ensure that they record details of discussions regarding complaints.
• They should ensure that relevant staff are involved in the investigation of significant events, and that the learning resulting from these incidents is shared and embedded.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice