Archived: Falklands Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Falklands Surgery on 26 April 2017. The overall rating for the practice was requires improvement, with requires improvement for providing safe and well led services and good for providing effective, caring and responsive services. The full comprehensive report on the 26 April 2017 inspection can be found by selecting the ‘all reports’ link for Falklands Surgery on our website at www.cqc.org.uk.

We undertook a focused inspection on 4 October 2017 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 26 April 2017. This report only covers our findings in relation to those requirements.

Overall the practice is now rated as good overall, and good for providing safe and well led services.

Our key findings from this inspection were as follows:

• Falklands Surgery is a partnership with East Coast Community Healthcare Community Interest Company (ECCH). At the time of this inspection, Falklands Surgery were planning to form a partnership with a different provider. Therefore, actions to share the ECCH visions and values with staff and attendance at ECCH senior management meetings had not been completed, as this was not felt to be appropriate due to the imminent partnership changes. Staff had been informed of the planned changes and told us they felt supported at this time of change.
• There were effective governance processes in place to identify, act on, monitor and review health and safety risks to patients and staff that were identified, including those that related to legionella, significant events and calibration testing.
• Staff had been trained in safeguarding children and vulnerable adults to a level appropriate to their role. Two members of non clinical staff who had joined the practice recently were due to complete safeguarding training and we saw evidence that the practice were monitoring the completion of this training.
• Information technology systems had improved so the practice could ensure ECCH was informed of all significant events and staff were able to complete mandatory e-learning training.
• Improvements have been made in relation to annual health checks for people with a learning disability registered at the practice. Staff had worked with a learning disability nurse and letter templates for patients had been agreed, although the practice planned to invite patients by telephone and then send a letter. The practice planned to offer a 30 minute appointment with a nurse, followed by a 30 minute appointment with a GP to complete the annual health check. Patients had been identified and were scheduled to be called according to their month of birth. The number of patients who had received a health check in the previous 12 months was 15 out of 30 patients, which was the same number as the inspection on 26 April 2017. However the practice advised that all patients would have been offered and received a health check by March 2018.
• Significant improvements had been made to the percentage of staff who had completed training deemed mandatory by the provider ECCH and who had received an appraisal.

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 Falklands Surgery on 26 April 2017. Overall the practice is rated as requires improvement.

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

• In January 2016, Falklands surgery formed a partnership with East Coast Community Healthcare Community Interest Company (ECCH), who are now the provider for the practice. ECCH is a provider of over 30 community services, which includes four GP practices and has been established for five years.
• There was an open and transparent approach to safety. There was an effective system in place for reporting and recording significant events within the practice; however East Coast Community Healthcare Community Interest Company (ECCH) were not aware of all significant events, as the practice had not used the electronic incident reporting system to inform ECCH.
• Patient safety alerts were logged, shared and initial searches were completed and the changes effected. A pharmacist worked at the practice three days a week to support this work.
• Health and safety risks to patients and staff were identified but were not always acted upon in a timely way.
• 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. However some staff had not received training deemed mandatory by ECCH.
• Patients said they were treated with 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 improvements were made to the quality of care as a result of complaints and concerns. This was actioned at the practice level and monitored by ECCH. Trend analysis of complaints was undertaken and published on the ECCH website.
• Patients said they found it easy to make an appointment with a GP with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. ECCH had supported a number of initiatives which had been implemented and were being planned to improve the service that patients received. 
• ECCH had a clear vision and set of values; however some staff at the practice were not aware of these. Whilst staff felt supported by local leadership, the expectations of improved leadership by ECCH, had not been fully achieved. The communication between the provider and the location was not always effective. This had resulted in delays in information being shared and recommendations being acted upon. For example sharing of significant events, undertaking a legionella risk assessment, calibration of medical equipment and portable appliance testing.

The areas where the provider must make improvement are:

• Ensure there are effective governance processes in place to identify, act on, monitor and review health and safety risks to patients and staff that are identified, including those relating to legionella, significant events and calibration testing.
• Ensure staff are trained in safeguarding to a level appropriate to their role.

The areas where the provider should make improvement are:

• Continue to work towards embedding effective information technology to ensure the provider is informed of all significant events raised at the practice and to enable staff to undertake mandatory training.
• Improve staff understanding and knowledge of ECCH in order that they feel more supported.
• Encourage the uptake of annual health checks for people with a learning disability registered at the practice.
• Ensure that all staff complete training deemed mandatory by ECCH and that annual appraisals are completed with all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice