Archived: Lostock Hall Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lostock Hall Medical Centre, Lostock Hall, Preston PR5 5SA on 26 June 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Significant events and patient complaints were a regular agenda item and discussed in practice meetings. However, minutes of practice meetings lacked details of these discussions and any actions taken as a result of incidents or lessons learned to prevent recurrence.
• The practice had insufficient systems in place to minimise risks to patient safety. There was a backlog of scanning documents such as hospital letters onto electronic patient records, some dating back to November 2016, which posed a potential risk of important correspondence being missed. These documents had been selected by non-clinical staff and not seen by the GP with no protocol or audit process in place. The practice told us that they would address this immediately.
• The practice added summary information from paper patient notes onto the patient electronic health record system, however, only 23% of patient records had been summarised. This posed a risk of missing patient historical health information on the patient computerised record.
• We were told that patient safety alerts were acted on by staff, however, the practice lacked protocols to ensure that they were dealt with appropriately and they were not kept for information for locum GPs.
• 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. However, we found three members of staff had not received relevant safeguarding training.
• Practice recruitment procedures were comprehensive and newly appointed staff had all received timely performance reviews, although two staff members who had been at the practice for over 12 months had not had an appraisal.
• Blank prescription forms and pads were securely stored, however, there were no systems in place to record the distribution of blank prescription forms to GPs or for monitoring their use. Blank prescription pads were not monitored at all. Vaccine fridges were not plugged into switchless sockets or plugs labelled to prevent accidental disconnection.
• The practice had a variety of risk assessments to monitor safety of the premises, however, control of substances hazardous to health (COSHH) data sheets were not available for the cleaning products used within the practice.
• 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.
• Information about services and how to complain was available, however, this information was not freely available with patients having to ask at reception for a complaints leaflet.
• Patients we spoke with said they found it easy to make an appointment however this was not always with their preferred GP. Patients told us urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There were no embedded systems to evidence the review of areas of quality improvement such as NICE (the National Institute for Health and Care Excellence) guidance, patient safety alerts, and any actions taken as a result of these.
• There was a clear leadership structure and staff felt supported by the GP and practice manager.
• The practice had recently established a patient forum to gather feedback from patients. The first meeting of the group was held on 21 June 2017.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• Staff said they felt respected, valued and supported, particularly by the GP in the practice. However, staff also told us that they were experiencing pressure due to trying to catch up with the extra workload associated with the backlog of patient communications that had not been entered onto the patient computerised records.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvement are:

• Minimise the risks of accidental disruption of the power supply to the refrigerators used to store vaccines in accordance with guidance from Public Health England.
• Make information on how to complain easily available to patients in the reception area.
• Introduce protocols for dealing with patient safety alerts, clinical guideline changes, significant events and patient complaints to evidence discussion and actions taken and share learning.
• Complete the practice training programme with all staff members including safeguarding training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice