Archived: Brailsford & Hulland Ward Medical Practice

We carried out an announced follow up inspection at Brailsford & Hulland Ward Medical Practice on 11 October 2022 and carried out our remote clinical searches on 6 October 2022.

Overall, the practice is rated as requires improvement. It is rated as requires improvement for providing a safe service to patients, good for providing an effective service and requires improvement for providing a well-led service. Due to assurances we received from our review of information, we carried forward the ratings of good from our previous inspection in November 2021 for the key questions caring and responsive.

Following our previous inspection on 8 November 2021, the practice was rated as requires improvement overall. It was rated as good for all key questions apart from safe and effective which were rated as requires improvement.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Brailsford & Hulland Ward Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up on:

• Key questions safe, effective and well-led
• Breaches of regulation and shoulds from the previous inspection.
• In response to concerns reported to us.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Use of staff questionnaires to gather feedback from staff.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall.

We rated the practice as requires improvement for the key question safe. This was because:

Since our inspection in November 2021, improvements had been made in staff training; fire drills had been completed; there was equipment in place to monitor oxygen saturations in children; cleaning schedules were in place for most rooms within the practice; hospital letters and test results were followed up in a timely manner and diabetes reviews were carried out by an appropriate clinician.

However:

• Recruitment checks were not always carried out in accordance with regulations. Assurance was not gained regarding recruitment and support for Primary Care Network staff working within the practice.
• The provider’s system for monitoring that professional registrations were current and in date operated ineffectively
• Opportunities to carry out risk assessments had been missed. In particular, staff who did not have hepatitis B immunity and staff whose Disclosure and Barring Service check had not been completed.
• Action plans were not in place, or lacked detail, in response to risk assessments for fire, legionella and infection prevention and control. Spot checks to ensure the cleanliness of the practice had not been embedded into practice.
• Sharps and cytotoxic clinical waste bins were not always dated and disposed of in line with national guidance within the dispensary.
• Patient medicine reviews lacked details of specific medicines.
• The practice did not have a process in place to be assured of the competency of dispensing staff.
• Near misses were not always recorded in the dispensary and the system for managing safety alerts was not consistently applied.
• A system to identify trends in significant events and oversight of this at provider level was not in place.

We rated the practice as Good for the key question effective. This was because:

Since our previous inspection in November 2021, improvements had been made:

• Most clinical staff had completed mandatory training.
• A system was in place for monitoring key training completed by locum GPs.
• Our remote searches showed that annual health reviews for patients with COPD and asthma were being completed.
• Patients with long-term conditions were offered timely medication reviews.
• We found evidence that the practice had processes in place to improve the uptake of the Measles Mumps and Rubella (MMR) vaccine in children.

However:

• Not all staff had received a recent appraisal.
• Clinical audits lacked details of the actions taken in response to the findings.

We rated the practice as Requires Improvement for the key question well-led. This was because:

Since our previous inspection we found that a clinical lead and practice manager had been recruited to provide day to day onsite support.

However:

• Complaints had not been included in the quality and improvement meetings to drive continuous improvement.
• A policy had not been developed to support patient safety when accessing remote services.
• Policies did not always reflect national guidance. In particular, maintenance of the cold chain, consent, infection prevention and control and vaccine storage.
• The business continuity plan had not been updated since the new provider had taken over the practice.
• Most staff where not aware if there was a vision or strategy for the practice.
• Some staff felt their views were not always listened to or acted upon and there was a lack of transparency.
• Opportunities to carry out risk assessments or act on findings from risk assessments had been missed.

We found two breaches of regulations. The provider must:

• Ensure specified information is available regarding each person employed and where appropriate, persons employed are registered with the relevant professional body.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

• Put in place a cleaning schedule for the reception area and embed the planned cleanliness spot checks into practice.
• Provide all specific medicine details in patient medicine reviews.
• Align the frequency of actual fridge temperature checks with guidance in the practice’s policy for the storage of vaccines.
• Continue to follow up children that have not attended for two doses of the measles, mumps and rubella vaccination.
• Complete clinical audits to ensure issues identified are followed up appropriately.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services