Thursby Surgery

Letter from the Chief Inspector of General Practice

This is a focused desk top review of evidence supplied by Thursby Surgery, for one area only, overview of safety systems and processes, within the key question safe.

We found the practice to be good in providing safe services. Overall, the practice is rated as good.

The practice was inspected on 21 April 2016. The inspection was a comprehensive inspection under the Health and Social Care Act 2008. At that inspection, the practice was rated ‘good’ overall. However, within the key question safe, overview of safety systems and processes was identified as requires improvement, as the practice was not meeting the legislation at that time; Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

At the inspection in April 2016 we found that; infection prevention and control audits had not been routinely carried out to improve infection prevention and control arrangements, the cleaning schedule did not cover routine cleaning of all areas and there had been no COSHH assessments of cleaning materials. There was no protocol or procedure for cleaning up spillage of bodily fluids. Some clinical staff had not completed immunisation training in the last year. Not all emergency medication was available.

The system for authorising patient group directions required review to ensure they were signed. In addition the safeguarding policy has been updated to include more detail about adult safeguarding. The protocol for lone working had been updated to include visits out of hours.

The practice supplied an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

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 Thursby Surgery on 21 April 2016. Overall the practice is rated as good.

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

• The practice provided eye catching and informative health information displays in the waiting areas. One display included empty soft drinks bottles and bags containing the equivalent amount of processed sugar in each drink. Alongside this was information on sugar, diabetes and the impact on health. The practice was discussing whether it was possible to take this into local schools as a presentation at the time of our visit.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed but some areas required further work to meet guidance. For example, there had been no completed infection prevention and control audits at the time of our visit and whilst we observed the practice to be clean throughout, there was no evidence that all areas were being cleaned to meet NHS guidance.
• Two practice nurses and the health care assistant had not attended immunisation refresher training in the last twelve months.
• 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 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 told us they did not always find it easy to make an appointment with a named GP, although a GP assessed requests for urgent appointments and spoke with patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Emergency equipment and medicines were available and in date, although no atropine was available.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, on which it acted.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are:

• Ensure adequate arrangements are in place to address IPC to patients including carrying out infection prevention and control audits; maintaining a cleaning schedule; reviewing spillage of bodily fluid procedures and conducting COSHH assessments of cleaning materials.
• Ensure that emergency medicines include all those recommended for all activities carried out by the practice, specifically atropine for emergency treatment if required, during the fitting of contraceptive coils.
• Ensure that all staff conducting immunisations receive timely annual training updates.

The areas where the provider should make improvements are:

• Complete the work on reviewing local policies and procedures including the business continuity plan.
• Keep records of supervision and meetings for nurses
• Review the procedures to maintain patient privacy when undressing in the clinical rooms.
• Complete two-cycle clinical audit to ensure audit is consistently improving patient outcomes.
• Setting up the hearing loop and information sign this so that patients are aware they can request this and providing written information in Urdu in the waiting areas to reflect this population group.
• Review the complaints handling process to ensure the complainant is advised of their right to take their complaint to the Parliamentary and Health Services Ombudsman (PHSO) in written responses to complaints.
• Review the system for authorisation of all patient group directions to ensure they are signed in a timely way.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice