13 January 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Christopher practice on Wednesday 13 January 2016. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
- Staff understood their responsibilities to raise concerns and to report incidents and near misses, however the practice did not have a formal system in place for recording and monitoring significant events, incidents and accidents.
- The practice did not have a programme of continuous clinical and internal audit in order to monitor quality and make improvements.
- There was insufficient monitoring of performance to demonstrate people received effective care and treatment.
- Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
- Urgent appointments were available on the day they were requested. Patients said that they sometimes had to wait a long time to be seen at their appointment but accepted this as they were more than happy with the level of care provided by the GP.
- The practice had limited formal governance arrangements in place.
- There was a clear leadership structure and staff felt supported by the management. The practice did not proactively seek feedback from patients to ensure patients were involved in the delivery of the service.
The areas where the provider must make improvements are:
- Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include arrangements for recording, analysing and acting upon significant events and improving the monitoring and recording of staff training.
- Ensure that staff who undertake the role of a chaperone have a Disclosure and Barring (DBS) check or an appropriate risk assessment carried out to demonstrate why a DBS check is not in place and how patients are protected from the risk of abuse during an examination.
- Implement robust governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided. This should include undertaking audits of practice, including completed clinical audit cycles.
- Implement systems for the management and monitoring of performance to demonstrate people received effective care and treatment. This should include patients with long term conditions such as diabetes and asthma and patients with dementia.
The areas where the provider should make improvement are:
- Consider repeating the risk assessment for legionella as recommended in the report and ensure a copy of the outcome and a policy is available at the practice to provide guidance for staff.
- Have a system in place to record, investigate and demonstrate the outcome of written and verbal complaints received.
- Ensure all staff receive training in the protection of vulnerable adults.
- Ensure that fire drill training/practice sessions take place for all staff.
I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of 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 to varying the terms of their registration within six months if they do not improve. The practice 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 by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice