Archived: The Surgery, Ashby

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery Ashby on 29 June 2017.

Breaches of legal requirements were found in relation to safeguarding service users from abuse and improper treatment and governance arrangements within the practice.

We issued the practice with two warning notices requiring them to achieve compliance with the regulations set out in those warning notices by 20 October 2017.

We undertook this focused inspection on 6 December 2017 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.

At the inspection on 6 December 2017 we found that not all the requirements of the warning notices had been met.

Our key findings across the areas we inspected for this focussed inspection were as follows:

• The practice had made improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe. Further work was required in regard to patient safety alerts, significant events, fire safety, management of legionella and quality improvement. Further evidence was required to demonstrate shared learning in regard to discussion and actions from significant events, complaints, NICE guidance and quality improvement. Meeting minutes needed to be more detailed.

• Safe systems were now in place for high risk medicines, monitoring of the cold chain, patient group directives, staff recruitment and training, policies and procedures.

• Effective systems were now in place to safeguard service users from abuse and improper treatment.
• At this inspection we still had concerns in regard to the leadership capacity and clinical oversight of the practice.

As the legal requirement of the warning notice for Regulation 17 was not met in full the Care Quality Commission has issued a requirement notice in which we require the practice to send us an action plan on how they will meet these requirements.

The areas where the provider must make improvements are:

• Put in place an effective system for the management of patient safety alerts.

• Continue to review the system in place for significant events to ensure all events are captured, investigations are detailed, actions are identified and implemented. Ensure trends are analysed and action is taken to improve the quality of care as a result

• Complete the required actions from the October 2017 legionella risk assessment.

• Further review the arrangements in place for quality improvement to monitor and improve patient outcomes.

• Further consolidate the complaints process and ensure all complaints are captured and learning from complaints is documented, discussed and shared with staff. Ensure trends are analysed and action is taken to improve the quality of care as a result.
• Embed a formalised process for the recording of meeting minutes and have a set agenda to ensure learning is shared and actions are put in place.

• Ensure there is leadership capacity and clinical oversight in the practice.
• Ensure Care Quality Commission inspection report ratings are displayed in the practice.

In addition the provider should:

• Ensure there is monitoring for external training required by staff members.

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 Surgery Ashby on 29 June 2017. Overall the practice is rated as inadequate

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

• Patients were at risk of harm because some systems and processes in place were not effective to keep them safe. For example, patient safety alerts, infection control, monitoring of patients on high risk medicines, monitoring of the cold chain, patient group directives, staff files and complaints.

• There was a system in place for reporting and recording significant events but it was not consistent or clear. Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• The practice did not have effective systems in place to safeguard service users from abuse and improper treatment.
• Most risks to patients were assessed but not well managed. For example, general health and safety, legionella and fire safety.
• We saw limited evidence of quality improvement to improve patient outcomes.
• The practice did not have an effective system in place to monitor the training of the GPs and staff within the practice. For example, not all staff had received appropriate training in safeguarding, mental capacity awareness, infection control and information governance to ensure they were up to date with current procedures.
• Feedback from people who use the service and stakeholders was consistently and strongly positive. Forty four patients expressed high levels of satisfaction about all aspects of the care and treatment they received. The feedback from comments cards we reviewed said patients felt they were treated with care, compassion, dignity and respect.
• Data from the July 2017 national GP survey was also consistently high.
• The practice had a number of policies and procedures to govern activity, but most were overdue a review.
• The practice had insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure patients are protected from abuse and improper treatment.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular, significant events, patient safety alerts, infection control, legionella, fire safety, staff files, patient group directives, training of staff, NICE guidance, quality improvement, complaints, shared learning from significant events and complaints, policies and procedures.

• Ensure there is leadership capacity to deliver all improvements.

In addition the provider should:

• Arrange infection control training for the lead nurse.
• Ensure all staff have received Mental Capacity awareness training.
• Improve the process in place for obtaining consent to treatment.
• Ensure patients are aware that translation services are available.
• Embed a formalised process for the recording of meeting minutes

.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice