Aldborough Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Aldborough Surgery on 22 June 2017. The overall rating for the practice was requires improvement, with requires improvement for providing safe and well led services. The full comprehensive report on the 22 June 2017 inspection can be found by selecting the ‘all reports’ link for Aldborough Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 08 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 22 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good, and good for providing safe and well-led services.

Our key findings were as follows:

• All equipment in the emergency trolley was in date. There was a comprehensive policy and log in place to support the new system.

• All prescriptions were signed by the relevant clinician prior to being dispensed to patients.

• The practice had implemented a new written consent form for minor surgeries. The records we viewed showed this was being used. The practice ran monthly audits on all patients who had undergone minor surgery to ensure consent had been gained in the appropriate way. The audits showed there was an effective system in place and all patients had written consent recorded where this was appropriate.

• The practice had taken action relating to fire and legionella risk assessments and these were recorded appropriately.

• There was a system in place to monitor the use of blank prescription stationary which was in line with relevant guidance.

• The practice had a new meeting agenda in place to ensure effective sharing of all significant events within the practice. These were attended by all staff within the practice.

• The management team could demonstrate improved oversight of safety within the practice and had implemented a new meeting schedule to improve communication within the practice and with external stakeholders.

Further improvements from the last inspection included:

• The practice had actively been educating patients on the shared summary care records, which allows patients records to be shared between healthcare services, with consent. Records showed that in the previous two months, consent for this had increased.

• The practice had reviewed the flu vaccination recall system and as a result had vaccinated 175 more patients than the end of the flu season last year. This was still ongoing at the time of this inspection.

• The practice had been proactive in inviting patients for health checks and had utilised text messages as a communication method.

• The practice offered contraceptive implants to patients. Due to the rural location of the practice and surrounding areas, the practice also accepted referrals from other local practices. The practice ensured there was flexibility in the appointments system to allow for increasing referrals and carried out extra clinics when demand was higher to ensure this did not impact negatively on registered patients. A salaried GP was also working with the local clinical commissioning group to develop a similar service for the fitting of implants to reduce menstrual bleeding. This service was currently only offered in secondary care and the practice was keen to set the service up to reduce travel and referral waiting times for patients.

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 comprehensive inspection at the Aldborough Surgery on 22 June 2017. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events. Dispensary near misses were also recorded as significant events. However, the practice had not carried out an annual trend analysis of significant events.
• The practice had some systems in place to minimise risks to patient safety. However, we found out of date equipment on the emergency trolley. The provider took immediate action in relation to this finding on the day of our inspection.
• The dispensary did not ensure all repeat prescriptions were signed before they were dispensed. The practice did not record receipt of blank prescription pads but did track them through the practice.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice ran a training academy which held external training courses and was available to other local practices. This covered training which was deemed mandatory.
• The practice gained verbal consent for minor surgical procedures, however did not always obtain written consent.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice were proactive in identifying patients with caring responsibilities, and had identified 4.4% of their patient population as carers.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had set up a Long Acting Reversible Contraception (LARC) clinic and were accepting referrals from two other local practices.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Ensure care and treatment is provided in a safe way to patients.

• Ensure that care and treatment of patients is only provided with the consent of the relevant person.

The areas where the provider should make improvements are:

• Implement a process to ensure actions taken following risk assessments carried out are clearly documented.

• Review the system for monitoring of blank prescription stationery.

• Review trends following significant events and near misses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice