Archived: Whitestone Surgery

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 4 quality statements from this key question. We found the provider continued to not have clear and effective governance processes, which supported the safe delivery of care. Copies of current and / or updated policies and procedures and audit reviews were not provided to show that staff would have clear guidance on their individual responsibilities and know who was accountable for each aspect of the service. The lack of evidence did not provide assurances that if the provider returned to the practice, they had the leadership capacity and capability to effectively drive sustainable improvements in the quality and safety of the service.

At this assessment, there continues to be insufficient assurances as to how the identified risks would be mitigated. We found areas of concern, which would continue to expose people to the risk of harm should the suspension be lifted. These included ineffective governance arrangements, unsafe care and treatment in relation to medicines and in the management of people with long term conditions.

There was insufficient evidence of effective systems and processes, transition plans, and governance structures in place to ensure the quality and safety of the service. This did not provide assurances that the provider could effectively manage the service and oversee all clinical and governance areas to minimise any future risks.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

At this assessment, the provider as leader for the service did not assure us that they had the capability to fully address the ongoing concerns initially identified at the inspection carried out in January 2024. This meant that patients would remain at risk of harm.

The provider did not share evidence of clear and effective processes for managing risks, issues and of performance to ensure patient safety as discussed with us during the interview. An example, of this included confirmation on the emergency medicines to be held at the practice. Evidence the provider shared with us did not clarify what emergency medicines would be held and what would not, and the rationale for those decisions. We could not be assured that Dr Sacha Simon had adequately considered or mitigated the risks to patients in the event of a medical emergency if the suspension was lifted.

The action plan the provider shared with us did not demonstrate that they understood the challenges to quality and sustainability or that they had identified the areas necessary to address these. There was no clear leadership structure to support effective accountability. The opportunities to develop and improve services for the practice population were not recognised.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During the assessment interview, the provider discussed governance arrangements that would be implemented at the practice. This included ongoing audits of medicine management and oversight of patients diagnosed with long term conditions. Following the interview, documents we received made reference throughout to audits that would be completed. However, we were not provided with completed audits, to demonstrate that the concerns identified during CQC’s assessment in January 2024 and July 2024 would be addressed. To provide the necessary assurance we required comprehensive documentation beyond references to audits and risk assessment templates. For example, in areas such as safeguarding and medicine management to demonstrate that governance would improve and be maintained.

The evidence we received in the area of medicine management showed some improvement for example, policies were better written and contained more information. However, there were still some gaps and some policies were generic and did provide assurance that staff had clear guidance to manage medicines. This meant it would not always be clear if medicines would be managed in a consistent way.

We found that the lack of clinical oversight remained a concern. For example, some of the new processes the provider had planned to put in place involved clinical oversight from a pharmacist. Their role would include for example, the review of patients prescribed high risk medicines and the review of patients with diabetes. At the time of the assessment the CV for the pharmacist provided as evidence, did not demonstrate they had the relevant experience and competency required for the role. The evidence the provider shared with us did not assure us that medicines would be managed safely.

During the interview we asked Dr Sacha Simon about what liaison had taken place with the caretaker practice, the Primary Care Network (PCN) and the Integrated Care Board (ICB). This was to understand what processes had been implemented, what improvements had been made and how they could return to practice, ensuring a smooth transition. We asked Dr Simon for evidence of the communication that had taken place for example, emails, minutes of meetings or an action plan for the transition process to support the handover. This evidence was not received. We could not be assured there was a strong working relationship between Dr Simon and the other agencies to implement changes and maintain the improvements that had been made by the caretaking team.

The absence of a clear and effective transition process meant there was a risk that patients continuity of care would be affected during the transition and that risks to patients were not safely managed during this period.

During the assessment interview the provider discussed staff and the additional responsibilities that they were going to take on. These included carrying out medicine audits and checking patient test results. The provider told us that staff would receive the required training to ensure they were competent in undertaking any extension to their role. Training certificates we received as evidence showed training topics and the date of completion but did not explain what content had been covered during the training. For example, a training certificate showed that a practice nurse had undertaken training on the interpretation of blood results. The absence of clear information on the scope of the training meant that we could not be assured of the level of training completed and if this would enable staff to review all blood results and make decisions including when to escalate abnormal results.

During the assessment interview details of up to date medicine administration training completed by the Healthcare Assistant (HCA) was not shared with us. The HCA told us that they had been ticking the completed medicine review box on patients records, which was out of their scope of practice and meant patients had not received a full medicine review. Our concern was that this could have been going on for some time but was not picked up by the provider as part of their own quality assurance process. This meant medicine reviews had not always been completed by an appropriate and qualified clinician to ensure patients were not exposed to the risk of harm.

In the absence of specific details of the training received by the HCA, there remained a risk that the HCA did not have the necessary knowledge to know when to escalate concerns when reviewing patients with long term conditions. Evidence provided following the assessment interview with the provider did not reference any plans for the clinical oversight and supervision of work carried out by the HCA to ensure the safety of patients.

The evidence of the training the provider intended staff to undertake to support them in their extended roles was not comprehensive. Certificates of completion of training were made available, but these did not show the content of the training undertaken. We could not be assured that staff would be suitably trained and competent to undertake the additional responsibilities and there would be effective clinical and governance oversight.