Archived: Northbourne Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northbourne Surgery on 18 October 2016. This inspection was undertaken following the period of special measures. Overall the practice is now rated as requires improvement.

Following the inspection in March 2016 the practice was rated as inadequate overall. The practice was inadequate in safe, effective, responsive and well led; and requires improvement in caring. Two warning notices were served which related to the safe care and treatment of patients and good governance of the practice. We carried out an inspection in July 2016 to assess the improvements needed as identified in the warning notices. The Care Quality Commission was satisfied that the areas within the warning notices were addressed adequately.

As part of this inspection in October 2016 we completed a comprehensive inspection and in particular reviewed the areas which did not meet the regulations following our inspection in March 2016 which were:

• There was a lack of systems to ensure there were appropriate staff trained and checked as suitable to act as chaperones.

• Investigation results and other reports were not reviewed and acted upon in a timely way.

• Patients on high risk medicines did not have these reviewed at regular intervals with required blood tests being carried out, to ensure they were being prescribed appropriately.

• Processes for medicines management including handling, administration, storage and prescription did not protect patients from harm.

• Infection control processes and cleaning regimes of equipment and the premises did not protect patients form harm.

• Checks and storage of emergency equipment and medicines were not effective and placed patients at risk of harm.

• There was a lack of formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. This placed patients and others at risk of harm. This included managing significant events, incidents and near misses; systematic updating of policies and procedures to ensure they were current and relevant; ensuring there were suitable numbers of staff who were competent to carry on the regulated activities; engaging with staff and patients about how the practice was run; and ensuring the complaints system was accessible for all patients and concerns were responded to in a comprehensive manner.

• Patients were not proactively engaged in their care and treatment and appointments were not tailored to meet patient need.

The key findings from this inspection are:

• Significant input had been made to the running of the practice to make improvements to the governance and safe service for the benefit of patients.

• 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.

• A programme of appraisals had been put in place and appraisals had been carried out for all staff.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Recruitment processes were in line with the requirements of the regulations and we found all necessary checks had been made and recorded prior to a member of staff commencing employment.

• Emergency equipment and medicines were suitable for use and regular checks were in place.

• The infection control processes were now in place, which included maintaining records and audits of cleaning regimes to ensure patients were protected from harm.

• Governance arrangements had been reviewed and systems and processes were in place for assessing and monitoring risk and the quality of the service provision. These included managing significant events and complaints; reviews of policies and procedures and proactive engagement with staff and patients on the running of the service.

• 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 which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Continue to make sure the signing in book is completed by all staff or make other arrangements to confirm who is in the building.

• Continue to review patients on an individual basis prior to excepting them, to improve exception reporting rates for the Quality and Outcomes framework and to demonstrate effective care is provided.

• Review the use of patients only lancets, which are used when taking blood for blood sugar levels, and replace with single use items to minimise risk of infection.

• Continue to provide opportunities for patients to provide feedback on service provision.

The full reports published on 5 May 2016 and September 2016 should be read in conjunction with this report.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service. We will re-inspect the practice within one year.

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 inspection at Northbourne Surgery on 26 July 2016 to monitor whether the registered provider had met the requirements of the warning notices which were served following an announced inspection in March 2016. The timescale given to meet the requirements was 30 June 2016.

Two warning notices were served which related to regulations 12 Safe care and treatment; and 17 Good governance respectively of the Health and Social Care Act 2008.

Areas which did not meet the regulations were:

• Policies to ensure there were appropriate staff trained and checked to act as chaperones did not protect patients from harm.

• Investigation results and other reports were not reviewed and acted upon in a timely way to ensure patient received appropriate treatment and were not placed at risk of harm.

• Patients on high risk medicines did not have these reviewed at regular intervals with required blood tests being carried out, to ensure they were being prescribed appropriately.

• Processes for medicines management including handling, administration, storage and prescription did not protect patients from harm.

• Infection control processes and cleaning regimes of equipment and the premises did not protect patients form harm.

• Checks and storage of emergency equipment and medicines were not robust and placed patients at risk of harm.

• There was a lack of formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. This placed patients and others at risk of harm. This included managing significant events, incidents and near misses; systematic updating of policies and procedures to ensure they were current and relevant; ensuring there were suitable numbers of staff who were competent to carry on the regulated activities; engaging with staff and patients about how the practice was run; and ensuring the complaints system was accessible for all patients and concerns were responded to in a comprehensive manner. Patients were not proactively engaged in their care and treatment and appointments were not tailored to meet patient need.

At this inspection we found that the provider had taken action to meet the requirements of the warning notices.

Key findings:

• Emergency equipment and medicines were suitable for use and regular checks were in place.

• The infection control processes were now in place , which included maintaining records and audits of cleaning regimes to ensure patients were protected from harm.

• Governance arrangements had been reviewed and systems and processes were in place for assessing and monitoring risk and the quality of the service provision. These included managing significant events and complaints; reviews of policies and procedures and proactive engagement with staff and patients on the running of the service.

The Care Quality Commission is satisfied that the areas within the warning notices have been addressed adequately and the practice is now compliant with regard to the notices.

The full report published on 5 May 2016 should be read in conjunction with this report. The practice remains in special measures until a full comprehensive inspection is carried out by the Care Quality Commission. Therefore the overall rating remains inadequate.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Northbourne Surgery was previously inspected by the Care Quality Commission in May 2015. when we rated the practice as requires improvement overall. Specifically, the practice was rated as requires improvement for providing safe care, for providing responsive services and for being well-led. The practice was rated as good in the caring and responsive domains. Shortfalls were found in relation to infection control, recruitment processes, staff deployment, medicines management and governance.

We carried out an announced comprehensive inspection at Northbourne Surgery on 3 March 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment. Action had not been taken to improve identified shortfalls in infection control procedures.

• There was more than one version of some of the policies and procedures. Policies contained out of date information referencing dissolved organisations or entities such as primary care trusts and criminal record bureau checks.

• Staff could not identify the safeguarding lead at the practice.

• Staff were clear about reporting incidents, near misses and concerns but there was no evidence of learning and communication with staff.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement. There was limited evidence that the practice was comparing its performance to others; either locally or nationally.

• Most patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• Appointment systems were not working well and did not provide patient choice, so patients did not receive timely care when they needed it.

• The practice had no clear leadership structure and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Take action to address identified concerns with infection prevention and control practice.

• Ensure recruitment arrangements include all necessary employment checks for all staff as detailed in the regulations.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Ensure that blank prescription forms are handled in line with current national guidance, tracked through the practice and kept securely at all times.

• Ensure that patient group directives and patient specific directives are signed and dated on an individual record by each member of staff who is carrying out the delegated role.

• Ensure there are sufficient numbers of staff available to ensure there are no delays in scanning or coding documentation.

• Ensure regular checks of medicines and emergency equipment are in place to ensure they are in date, maintained and fit for use.

• Ensure there is proactive engagement with patients and staff.

The areas where the provider should make improvement are:

• Improve processes for making appointments to provide patients with real choice.
• Improve the range of clinical audits.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give patients who use the practice the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice