Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Somerset Healthcare on 14 April 2016. The overall rating for the practice was good, with the area of safe being rated as requiring improvement. The full comprehensive report on the 14 April 2016 inspection can be found by selecting the ‘all reports’ link for West Somerset Healthcare on our website at www.cqc.org.uk.

This inspection was an announced focused follow-up inspection of West Somerset Healthcare on 18 April 2017, to confirm that the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good, with the area of safe now rated as good.

At the inspection 14 April 2016 the areas where the provider must make improvement were:

• The practice must follow the guidance on the Control of Substances Hazardous to Health Regulations (2002) and ensure safety data sheets were available in the practice.

• The practice must follow the Electricity at Work Regulations (1989) with regards to electrical system maintenance.

• The practice must review fire safety in line with Health Technical Memorandum 05-01.

• The practice must review emergency system checks including emergency lighting and fire alarms.

• Systems must be in place for the effective prevention and management of infection for equipment used for diagnosis and treatment.

• All staff must receive safeguarding adults training in a timely manner and in line with Safeguarding Adults: Roles and competences for health care staff – Intercollegiate Document (2016).

• Patient records must be stored securely in line with national policy.

• The practice must review and risk assess the stock of emergency medicines with regard to the use of atropine for the treatment of bradycardia, as a possible complication of intrauterine device insertion.

The areas where the provider should make improvement were:

• Effective systems should be in place to record and review fridge temperature readings in a manner that will identify if vaccines had been stored safely.

• A system to record minutes from vulnerable adult meetings to allow for a single document which explained any actions which had been taken to improve quality of care and safety for this group of patients.

• Consent forms for patients who undergo insertion of intrauterine (contraceptive) devices should inform patients fully of the risks associated with the procedure including the potential risk to them if the practice does not stock the recommended emergency medicine.

• Effective systems should be in place to safely store and monitor the security of blank prescriptions as per practice policy.

This inspection was an announced focused inspection carried out on 18 April 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 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The provider had ensured there were safety data sheets available in the practice for the storage and handling of chemicals that were required to be kept in accordance to Control of Substances Hazardous to Health Regulations (2002).

• The practice had followed the Electricity at Work Regulations (1989) with regard to electrical system maintenance; an electrical hard wiring safety check had been carried out.

• The practice had reviewed fire safety in line with Health Technical Memorandum 05-01. Fire safety drills, fire safety training, emergency lighting, and external fire safety assessment had been carried out.

• Systems were in place for the effective prevention and management of infection for equipment used for diagnosis and treatment.

• All staff had received safeguarding adults training.

• Patient records were stored securely in line with national policy.

• The practice had reviewed their protocols in regard to the stocking of emergency medicine atropine (for the treatment of bradycardia, as a possible complication of intrauterine device insertion). The practice now ensured it was readily available when these procedures were carried out.

• Effective systems were in place to record and review refrigerator temperature readings to ensure vaccines had been stored safely.

• The provider had implemented a system to record minutes of vulnerable adults safeguarding meetings including any actions which had been taken.

• Effective systems were in place to safely store and monitor the security of blank prescription paper as per practice policy.

The provider should:

• The provider should continue to ensure that all staff remain aware of where the emergency medicine atropine was kept, so that they could respond appropriately if required for coil insertion procedures.

• The provider should continue to ensure that the emergency medicine atropine that is not held centrally with the other emergency medicines is checked in accordance with their emergency medicines policy.

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 West Somerset Healthcare on 14 April 2016. The overall rating for the practice was good, with the area of safe being rated as requiring improvement. The full comprehensive report on the 14 April 2016 inspection can be found by selecting the ‘all reports’ link for West Somerset Healthcare on our website at www.cqc.org.uk.

This inspection was an announced focused follow-up inspection of West Somerset Healthcare on 18 April 2017, to confirm that the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good, with the area of safe now rated as good.

At the inspection 14 April 2016 the areas where the provider must make improvement were:

• The practice must follow the guidance on the Control of Substances Hazardous to Health Regulations (2002) and ensure safety data sheets were available in the practice.

• The practice must follow the Electricity at Work Regulations (1989) with regards to electrical system maintenance.

• The practice must review fire safety in line with Health Technical Memorandum 05-01.

• The practice must review emergency system checks including emergency lighting and fire alarms.

• Systems must be in place for the effective prevention and management of infection for equipment used for diagnosis and treatment.

• All staff must receive safeguarding adults training in a timely manner and in line with Safeguarding Adults: Roles and competences for health care staff – Intercollegiate Document (2016).

• Patient records must be stored securely in line with national policy.

• The practice must review and risk assess the stock of emergency medicines with regard to the use of atropine for the treatment of bradycardia, as a possible complication of intrauterine device insertion.

The areas where the provider should make improvement were:

• Effective systems should be in place to record and review fridge temperature readings in a manner that will identify if vaccines had been stored safely.

• A system to record minutes from vulnerable adult meetings to allow for a single document which explained any actions which had been taken to improve quality of care and safety for this group of patients.

• Consent forms for patients who undergo insertion of intrauterine (contraceptive) devices should inform patients fully of the risks associated with the procedure including the potential risk to them if the practice does not stock the recommended emergency medicine.

• Effective systems should be in place to safely store and monitor the security of blank prescriptions as per practice policy.

This inspection was an announced focused inspection carried out on 18 April 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 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The provider had ensured there were safety data sheets available in the practice for the storage and handling of chemicals that were required to be kept in accordance to Control of Substances Hazardous to Health Regulations (2002).

• The practice had followed the Electricity at Work Regulations (1989) with regard to electrical system maintenance; an electrical hard wiring safety check had been carried out.

• The practice had reviewed fire safety in line with Health Technical Memorandum 05-01. Fire safety drills, fire safety training, emergency lighting, and external fire safety assessment had been carried out.

• Systems were in place for the effective prevention and management of infection for equipment used for diagnosis and treatment.

• All staff had received safeguarding adults training.

• Patient records were stored securely in line with national policy.

• The practice had reviewed their protocols in regard to the stocking of emergency medicine atropine (for the treatment of bradycardia, as a possible complication of intrauterine device insertion). The practice now ensured it was readily available when these procedures were carried out.

• Effective systems were in place to record and review refrigerator temperature readings to ensure vaccines had been stored safely.

• The provider had implemented a system to record minutes of vulnerable adults safeguarding meetings including any actions which had been taken.

• Effective systems were in place to safely store and monitor the security of blank prescription paper as per practice policy.

The provider should:

• The provider should continue to ensure that all staff remain aware of where the emergency medicine atropine was kept, so that they could respond appropriately if required for coil insertion procedures.

• The provider should continue to ensure that the emergency medicine atropine that is not held centrally with the other emergency medicines is checked in accordance with their emergency medicines policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited the main surgery in Williton and the satellite surgery in Watchet over two days. We met and spoke with 12 people over the two days. This included a representative of the patient partnership participation group (PPG). We spoke with GPs, practice nurses and healthcare assistants who were on duty. We obtained information and support from the administration staff which included the practice manager and receptionists. We observed how the two surgeries were run and looked at some of the facilities and information available to patients. We were provided with information and assistance before the inspection visits from the chair of the PPG. This information included the findings from the last PPG survey carried out for the year 2012/2013 which is a survey sent to patients to find out their experiences of the service.

When we spoke with the 12 people about their experiences of the surgery they told us they were very happy with the support and treatment they received. We spoke with people who had been using the surgery for many years and those who had joined more recently. Comments included, “Very good”, “Nothing to improve” and “Good.” Other comments were, “Very happy with GPs.”, “What I like is they come out to call you in, no impersonal screen in the waiting room to tell you to go in.” People told us they felt the GPs and other healthcare staff were always prepared and had an understanding of their history needs before they entered the consulting or treatment room. One person said, “I felt they were prepared and it was more personal.”

People found staff were approachable, friendly and supportive. People said, “Staff are lovely.”, “Friendly on the phone and face to face,” and “Pleasant.” People told us they found the atmosphere at both surgery locations comfortable and welcoming.