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Inspection carried out on 14 November 2017

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Meadows Surgery on 23 May 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for The Meadows Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 November 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 in May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • There were effective arrangements in place to assess, monitor, manage and mitigate risks in respect of health and safety. These included systems for addressing Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts; and reviewing patients’ medicines.
  • Effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care. In particular, systems were in place to assess, monitor and improve the quality and safety of the service, including those for up to date record keeping, such as for staff training; and there was a rolling programme quality improvement, such as completed cycles of clinical audits.
  • Sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed to meet the fundamental standards of care and treatment. In particular, staff had received and had a record of appropriate training relevant to their role, including infection prevention and control and safeguarding adults and children. Effective arrangements were in place to assess the competency of dispensary staff.
  • A risk assessment had been completed regarding the location of the vaccine storage fridge to ensure appropriate infection prevention and control.
  • Effective arrangements were in place for the security of blank prescription stationery when clinical rooms were not in use.
  • Arrangements for communication and records had been improved to ensure learning from complaints and incidents was shared and all actions were completed.
  • Arrangements for management & leadership had been improved to ensure all staff have clarity of role, these were embedded in teams and adequate capacity and contingency arrangements for absence were in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 23 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Meadows Surgery on 23 May 2017. Overall the practice is rated as Requires Improvement.

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

  • The practice offers dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy.
  • The practice participated in a local quality and outcomes framework, Somerset Practice Quality Scheme (SPQS), rather than the Quality and Outcomes Framework (QOF), to monitor practice performance and outcomes for patients. Quality and Outcomes Framework data for 2015/16 showed patient outcomes were at or above average compared to the national average.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, arrangements for sharing learning and ensuring action was completed were not fully implemented.
  • The practice had systems to minimise risks to patient safety with the exception of those relating to some aspects of safety alerts, medicines management, staff training and record keeping.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, we found gaps in the records of training.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However, the practice should ensure learning is shared with staff.
  • Patients we spoke with 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.
  • 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

  • Ensure care and treatment is provided in a safe way to patients. In particular, ensure there are effective arrangements in place to assess, monitor, manage and mitigate risks in respect of health and safety. These should include systems for addressing Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts; and reviewing patients’ medicines.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular, ensure systems are in place to assess, monitor and improve the quality and safety of the service, including those for up to date record keeping, such as for staff training; and for a rolling programme quality improvement, such as completed cycles of clinical audits.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment. In particular, to ensure that staff receive and have a record of appropriate training relevant to their role including in infection prevention and control; and safeguarding adults and children.

The areas where the provider should make improvement are:

  • Review arrangements for assessment of the competency of dispensary staff.
  • Risk assess the location of the vaccine storage fridge to ensure appropriate infection prevention and control.
  • Review arrangements for security of blank prescription stationery when clinical rooms are not in use.
  • Review arrangements for communication and records to ensure learning from complaints and incidents is shared and all actions are completed.
  • Review arrangements for management & leadership to ensure all staff have clarity of role, these are embedded in teams and adequate capacity and contingency arrangements for absence are in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice