Find out about the significant improvements made to patient care when we re-inspected Harraton Surgery.
Harraton Surgery serves 2,200 patients living around Washington, Tyne and Wear. In September 2015 the practice was placed into special measures after receiving an overall rating of inadequate, as well as a rating of inadequate for being safe and well-led.
During the latest inspection in May 2016, inspectors found that Harraton Surgery had made significant improvements in patient care. As a result, we gave the surgery a new overall rating of good.
Improvement: from September 2015 to May 2016
Incidents and investigations
What we found in September 2015
- Although staff understood their responsibilities to raise concerns, and report incidents and near misses, reviews and investigations when things went wrong were not sufficiently thorough. Any lessons learned were not communicated widely enough to support improvement.
What we found in May 2016
- New systems introduced to help demonstrate a safe track record, including improved arrangements for reporting and recording significant events.
- Significant events included as a standing agenda item for team meetings
- Staff knew how to report significant events and told us about improvements they made as a result of incidents. For example, because the vaccines refrigerator had been turned off accidently it was now wired into a switch-less socket
Staffing
What we found in September 2015
- Appropriate pre-employment checks were not carried out
- Safeguarding arrangements were unclear
- Not all staff who acted as chaperones had been Disclosure and Barring Service (DBS) checked
- Not enough staff in the administrative and cleaning teams
- Delays in sending patient referral letters as not enough staff were trained
What we found in May 2016
- Improved systems for safeguarding children and vulnerable adults
- Chaperone service was offered to safeguard patients and staff
- Improved recruitment processes and personnel files showed staff were of good character and suitable for their role
- Additional cleaning staff cleaned the practice each working day
- More administrative staff trained to clear the backlog of referral letters
Medicines management
What we found in September 2015
- Vaccine fridges were not fit for purpose
- Minimum and maximum fridge temperatures were not checked
What we found in May 2016
- Improved arrangements for obtaining, prescribing, recording, handling, storing, security and disposal of medicines
- A new, appropriately-sized vaccine fridge installed
- Minimum and maximum fridge temperatures checked regularly
- A second, independent, thermometer calibrated the internal fridge temperature
Arrangements for emergencies
What we found in September 2015
- Little evidence to show staff had received basic life support training
- Only one staff member was trained in fire safety
- Oxygen was available, but with no masks for children
- The business continuity plan was not specific to the practice, was out-of-date and did not include emergency contact numbers for staff
What we found in May 2016
- All staff received annual basic life support training
- Staff were trained in fire safety
- Oxygen was available with adult and children’s masks
- A new comprehensive business continuity plan for major incidents included emergency contact details for services and staff
What they said
Sue McMillan, Deputy Chief Inspector of General Practice for the North of England, said: “When we inspected the practice in May we found improvements had been made across the board. There is still some work to do and we shall continue to monitor the practice’s performance. I am confident that, if they keep going, Harraton Surgery can set an example that others will follow.”
Patient feedback
We received 17 CQC comment cards. The majority of people who responded were positive about the service they experienced - patients said they felt the practice offered a good service and staff were helpful, caring and treated them with dignity and respect.
Positive comments mostly related to staff, the ease of getting an appointment and their satisfaction with the treatment received.
The latest GP patient survey (published January 2016) showed 98% of patients were satisfied with their overall experience of the GP surgery compared to averages for the local Clinical Commissioning Group (88%) and England (85%).
Conclusion and recommendations
We rated the service as good overall and removed it from special measures in June 2016.
During our re-inspection we found the practice had made good progress in implementing improvements. Practice staff told us this had been their focus over the last six months, and they wanted to bring the practice up to the basic standard before they looked more widely at its future vision and strategy.
Although we could see that the practice had made many improvements it will take time to demonstrate that the level of improvement is sustainable.
We recommended that the practice:
- Considers the practice approach to appraisal so that all staff have the benefit of a collaborative appraisal, which clearly identifies performance and learning needs.
- Continues with the progress made with staff training to address any remaining gaps, to ensure staff have the knowledge and skills needed to do their job.
- Considers how it can ensure that the improvements already made are sustainable and that it has robust and effective succession planning.
- Continues to improve its approach to seeking and acting on feedback from patients and staff, to demonstrate continuous improvement and to be a ‘listening’ organisation.
Find out more
Case studies in improvement:
Special measures programme: All GP practices and out-of-hours services rated inadequate after inspection are placed into special measures so they do not continue to provide care that is not safe, effective or compassionate. They are re-inspected to ensure necessary improvements, outlined in their CQC inspection report, are made.
One of the best things about being a CQC specialist General Practice Inspector is working through improvement methodology with hard-working clinicians who are as delighted as we are when their hard work leads to better care for their patients.
Craig Dobson, CQC specialist GP inspector