The Green Practice

We carried out an announced inspection at The Green Practice on 22 June 2022, with the remote clinical review on 20 June 2022. Overall, the practice is rated as requires improvement.

Safe – Requires improvement

Effective - Good

Caring - Good

Responsive – Requires improvement

Well-led – Requires improvement

Following our previous inspection on 25 February 2020, the practice was rated as requires improvement overall, and specifically requires improvement for the safe, effective and well-led key questions. We rated the practice as good for the caring and responsive key questions.

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

Why we carried out this inspection

This inspection was a comprehensive inspection focusing on:

• Ensuring care and treatment was being provided in a safe way to patients.
• Establishing if there were effective systems and processes in place to ensure good governance in accordance with the fundamental standards of care.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short 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 this practice as requires improvement for providing safe services because:

• We found that reference checks had not been completed for one member of staff, which was not consistent with the practice’s recruitment policy.
• We identified issues with the monitoring of patients on some high risk medicines.
• We found that the system for managing and acting on Medicines and Healthcare Products Regulatory Agency (MHRA) alerts was not always effective.
• The premises were well managed, with effective systems for managing infection prevention and control.
• We found that emergency medicines and equipment on site were organised, in date and effectively managed.

We rated this practice as good for providing effective services because:

• The practice was effectively managing and monitoring long-term conditions.
• The practice had worked towards providing effective care for patients during the Covid-19 pandemic.
• The practice uptake for cervical screening was below the 80% coverage target for the national screening programme.
• The practice had achieved the uptake required for childhood immunisaition in some of the indicators and demonstrated an understanding of the barriers to uptake of immunisations and a commitment to improving uptake.

We rated this practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had arrangements for providing interpreters for patients who did not have English as a first language and made adjustments for patients to ensure access.
• The practice offered longer appointments for patients where appropriate.

We rated this practice as requires improvement for providing responsive services because:

• The system for managing complaints from patients was not comprehensive, with detail of lessons learned not clearly identified in the documentation we reviewed.
• We found that people’s needs were met through the way services were organised and delivered.
• The practice had maintained services throughout the Covid-19 pandemic and had continued to monitor long-term conditions and provide face to face appointments where appropriate.

We rated this practice as requires improvement for providing well-led services because:

• The practice had a governance framework, however it was not always effectively managing risks. These included the risks associated with prescribing medicines that required ongoing monitoring in line with guidance and the system for managing and acting on MHRA alerts was not always effective.
• The practice system for recording complaints and lessons learned was not comprehensive.
• The practice had been through a period of change after the death of a GP partner and had adapted and continued to provide services throughout this difficult time.
• Actions were taken to support the maintenance of the service during the Covid-19 pandemic.
• Staff spoke positively about their employment at the practice and felt supported.

We found breaches of regulations. The practice must:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

In addition to the above, the practice should:

• Identify ways to improve the uptake of childhood immunisations and address barriers to uptake in the patient population.
• Store blank prescriptions securely once allocated to GPs.
• Complete internal health and safety and fire risk assessments in more detail and include action plans.
• Display a fire evacuation procedure for patients on the premises.
• Encourage patients to use the interpreter service for language support if required, instead of using the services of family or friends.
• Continue to identify carers in the practice population, and ensure that these patients receive appropriate support and signposting.
• Display appropriate information and signposting for patients in the waiting area and on the premises.

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