Archived: Trent Valley Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trent Valley Surgery on 6 December 2016. Overall the practice is rated as good. The purpose of this inspection was to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings at our inspection in June 2015. At a further inspection in March 2016, some improvements were found, following which the practice was rated as requires improvement overall but remained in special measures.

Following the most recent inspection we found that overall the practice was now rated as good and significant improvements had been made and specifically, the ratings for providing a safe service had improved from inadequate to good. The rating for providing a caring service had improved from good to outstanding.

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

• The practice had made further significant improvements since our last inspection and the new staffing structure was working effectively.

• The most recent results from the national GP patient survey published in July 2016 ranked the practice seventh in England.

• Feedback we received from patients reflected positively about the staff and said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The new system which had been introduced at our previous inspection was now embedded and we saw that learning was disseminated and identified actions were implemented.
• The practice had a number of policies and procedures to govern activity, all of which had been reviewed.
• The practice had sought feedback from patients and the recently formed patient participation group was developing.

• Risks to patients were assessed and well managed (with the exception of legionella).

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand.
• Patients expressed high satisfaction with the appointment system and 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.
• The leadership structure had strengthened further and staff felt supported by management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• To ensure that daily resets of vaccination fridges are recorded.

• To review arrangements for mitigating the risk of legionella.

• To formalise supervision arrangements relating to the nurse prescriber.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 Trent Valley Surgery on 1 March 2016. Overall the practice is rated as requires improvement. The purpose of this inspection was to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings at our inspection in June 2015 when we found the practice to be inadequate overall.

Following the most recent inspection we found that overall the practice was now rated as requires improvement and significant improvements had been made and specifically, the ratings for providing a well led service had improved from inadequate to requires improvement. However the rating for providing a safe service remained inadequate.

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

• The practice had made significant improvements since our last inspection despite staffing issues.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, the system which had been introduced still required some improvement to ensure learning was disseminated and identified actions were implemented.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• The practice had sought feedback from patients and had recently formed a patient participation group.
• Some risks to patients were assessed but the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients spoke positively about the staff and 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 expressed high satisfaction with the appointment system and 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.
• The leadership structure had improved and staff felt supported by management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure robust processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and complaints are in place.

• Ensure robust systems are in place to assess and monitor risks in areas such as infection control, fire safety, health and safety, dealing with emergencies and dispensary processes.

• Ensure formal governance arrangements are operating in order that staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice, for example the cold chain policy, nurse protocols and standard operating procedures in the dispensary.
• Ensure blank prescriptions are handled in accordance with national guidance.
• Ensure staff have necessary training and competence to provide care or treatment safely, including competency checks for dispensary staff.

In addition the provider should:

• Ensure the safety alerts log is completed to record the actions taken as a result of alerts received by the practice.
• Ensure all staff have received an annual appraisal.
• Ensure that daily resets of vaccination fridges are recorded.
• Ensure patients’ privacy and dignity is protected at the branch surgery by the use of curtains in consulting and treatment rooms.

This practice was placed in special measures on 1 October 2015. Insufficient improvements have been made such that there remains a rating of inadequate for the safe domain. Therefore the practice will remain in special measures and kept under review. Another inspection will be conducted within six months to ensure the required improvements have been made. If the required improvements have not been made we will take action in line with our enforcement procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice