Archived: Falmouth Road Group Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Falmouth Road Group Practice on 29 April 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, caring, responsive and well-led services. It was also inadequate for providing services for older people, people with long-term conditions, families, children and young people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia). The practice was found to require improvement for providing effective services.

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

• Patients were generally positive about their interactions with staff and said they were treated with compassion and dignity, however a number of patients reported they would not recommend the practice.
• Significant events were reported and there was some evidence of learning and communication with staff. However some staff were not clear about the process for reporting incidents, near misses and concerns.
• Data showed patient outcomes were mostly at or below the average for the locality. Although two audits had been carried out, with some impact on patient outcomes, we saw no evidence that audits were driving improvement in performance long term.
• Patients were at risk of harm because not all systems and processes were in place to keep them safe. For example, safeguarding and chaperoning procedures were not robust, full recruitment checks on staff had not been undertaken prior to their employment and we identified some concerns with infection control practice, medicines management and risk management.
• The practice had received a number of complaints that were not always responded to in a timely manner.
• Patients had to walk into the surgery to book a same day appointment. Patients said that they frequently had to wait a long time for urgent and non-urgent appointments due to the current appointment system.
• The practice had a number of policies and procedures to govern activity, but policies were not easily accessible to staff. The practice did not hold regular governance meetings and issues were discussed at ad hoc meetings.
• The leadership structure was not always evident and the practice had insufficient management and strategic capacity.
• The practice had not proactively sought feedback from staff or patients.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Review systems and process for safeguarding people from abuse including safeguarding children training for all staff, safeguarding adult training for identified staff and transparent safeguarding processes for staff to follow.
• Ensure that staff performing chaperoning duties are able to safely carry out this role by providing chaperone training, a chaperoning policy and criminal records checks for all staff undertaking chaperoning duties where indicated.
• Improve medicines management processes to ensure adequate monitoring of all medicines, including disposal of expired medications.
• Ensure infection control procedures are robust by undertaking infection control and cleaning audits as required and providing infection control training for all staff.
• Ensure that fire risk assessments and health and safety assessments are carried out and updated as required.
• Ensure that the practice recruitment policy is updated and followed so necessary recruitment checks are recorded for all new employees.
• Ensure all clinical and non-clinical staff employed by the practice receive regular mandatory training appropriate to their role, including basic life support and fire training.
• Review and improve access to appointments for all patients and reduce waiting times for appointments.
• Ensure complaints procedures are clear and accessible to patients.
• Ensure adequate governance arrangements are in place to assist day to day management and strategic planning of the practice.
• Ensure practice policies contain adequate detail and are easily accessible to all staff.
• Ensure all staff receive an annual appraisal.

In addition the provider should:

• Ensure there is a process to routinely cascade patient safety alerts and discuss the impact of these with all staff.
• Keep a log of risks identified through practice risk assessments.
• Ensure there is a robust process by which adequate staffing levels can be maintained.
• Keep adequate and accessible staff training records and updated staff files.
• Ensure care planning is completed for all appropriate patients with long term conditions, including dementia and mental health.
• Complete patient surveys to identify areas to improve and use feedback to address practice issues.
• Gather feedback from staff regarding practice performance and have a process for staff to be able to raise concerns.
• Ensure the practice monitors performance through benchmarking and identifies needs of the population so service improvements can be targeted.
• Ensure clinical audits demonstrate completed audit cycles to show improved outcomes for patients.
• Ensure practice performance data is accurate by routine and appropriate use of the electronic patient record system.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice