Archived: South Reading Surgery Also known as South Reading & Shinfield Group Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of South Reading Surgery on 7 April 2017. This was to follow up on a warning notice the Care Quality Commission served following an announced comprehensive inspection on 11 January 2017 when the practice was placed into special measures.

The warning notice was served relating to regulation 12: Safe care and treatment of the Health and Social Care Act 2008. The timescale given to meet the requirements of the warning notice was 31 March 2017.

The January 2017 inspection highlighted several areas where the provider had not met the standards of regulation 12. These included:

• Emergency medicines held did not include some medicines required for emergency situations. Emergency equipment also had items missing or out of date.

• The practice was not complying with legal requirements relating to the health care assistant administering vaccines under a patient specific direction (PSD).

• The records of monitoring fridge temperatures were incomplete and showed occasions where the temperature had exceeded the upper recommended limit of eight degrees Celsius.

At this inspection in April 2017 we found that actions had been taken to address the emergency medicines and equipment and the PSDs. There were still concerns over the fridge temperature recording logs. Specifically, the practice had;

• Decided to stop administration of patient specific directions by the health care assistant and offer further training. Documentation of PSDs administered until February 2017 showed they had been offered in line with current legislation.
• Reviewed the emergency medicines and equipment and ensured they were regularly checked. The practice had reviewed the emergency medicines required and made arrangements to add these to the grab bag.
• Implemented a new recording form for documenting daily fridge temperature checks for the fridge in the main building. The fridge had been checked twice a day for every day the practice was open. However, there were still some breaches of the cold chain (exceeding eight degrees Celsius) on 16 occasions, since the last inspection in January 2017, which the practice had failed to escalate. The practice informed us they were working to new temperature parameters which was different to public health England (PHE) recommended guidelines for safe storage temperatures. However, the practice cold chain policy was in line with PHE guidelines.
• The fridge temperature recording in the portakabin treatment room remained inconsistently logged with gaps of up to three days on 14 occasions since the last inspection in January 2017. The practice had informed CQC they had removed the fridge since the inspection in April 2017 as it was no longer in use.

Areas where the practice must improve:

• Ensure all fridges used for storage of medicines remain within the correct temperature parameters and breaches outside these temperatures are escalated according to policy.

We have focused on the warning notice findings in respect of the safe domain and have not re-rated South Reading Surgery. The full report published on 16 March 2017 should be read in conjunction with this report.

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 South Reading Surgery on 11 January 2017. Specifically, we have rated the practice as inadequate for the provision of safe and well led services and requires improvement for the provision of caring and responsive services. The practice was rated good for providing effective services. The concerns which led to these ratings apply to all population groups using the practice. 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 systems and processes were not in place to keep them safe. For example, electrical wiring and fire risk assessments identified high risk actions which had not been carried out in a timely way. In addition, the practice had not undertaken health and safety risk assessments, including legionella. Some aspects of the legislation regarding the control of substances hazardous to health (COSHH) were not being met.
• Monitoring arrangements for the administration of medicines had failed to identify that the appropriate legal requirements were not being followed when the health care assistant administered vaccinations.
• Provision of emergency medicines had not been reviewed and the process in place for checking emergency equipment was inconsistent with some out of date equipment found.
• Individuals in lead roles had not received training to enable them to carry out their work.
• The fridge temperature logs were completed inconsistently. Some identified cold chain breaches had no documented actions.
• Not all recruitment checks for new members of staff had been undertaken prior to their employment.
• Complaints were dealt with inconsistently and documentation did not accurately reflect actions taken or outcomes for learning.
• Information about services and how to complain was not on display and there was no feedback box available to offer patients the opportunity to complain anonymously.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
• The practice had limited leadership capacity and informal governance arrangements.
• Practice policies and protocols were kept under review but updates were not always shared with staff.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, we found many staff had undertaken large amounts of e-learning in a short space of time, which meant staff were unable to retain the information from the training.

There were, however, areas of good practice:

• Patients registered at the practice could also be seen at another nearby practice, managed by the same organisation, if this was more convenient for them.
• Patients said they could obtain urgent appointments on the same day and received continuity of care. The practice had reviewed appointment systems and was introducing a revised more flexible appointment system within two weeks of this inspection.
• There was an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• The practice had appropriate facilities and was well equipped to treat patients and meet their needs, despite the constraints of the premises.

The areas where the provider must make improvements are:

• Ensure systems to assess, monitor, manage and mitigate risks to the health and safety of service users are implemented. This includes the assessment and monitoring of infection control, medicines management and recruitment checks.
• Implement formal governance arrangements including systems for assessing and monitoring risks, including health and safety, electrical and fire safety, legionella and COSHH.
• Ensure the views of patients expressed in the national patient satisfaction survey are considered in order to improve the delivery of care and treatment.

The areas where the provider should make improvements are:

• Ensure arrangements are in place for patients diagnosed with a learning disability to receive an annual health check.
• Ensure updates in practice policies and protocols are shared with staff in a timely manner.
• Ensure learning from complaints is clearly identified and shared consistently with staff of all grades and disciplines.
• Ensure staff receive suitable training for lead roles.
• Review the identification of carers and improve support.
• Improve patient awareness of access to translation and bereavement services and consider installing a hearing loop.

I am placing this service in special measures. Services 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 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 by adopting our proposal to remove this location or cancel the provider’s registration.

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