The Care Quality Commission
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Archived: Tollerton Surgery

Overall: Good read more about inspection ratings

5-7 Hambleton View, Tollerton, York, North Yorkshire, YO61 1QW (01347) 838231

Provided and run by:
Tollerton Surgery

Important: The provider of this service changed. See new profile

All Inspections

11 December 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tollerton Surgery on 7 June 2017. The overall rating for the practice was good but the safe key question was rated as requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Tollerton Surgery on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 11 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 7 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.

Our key findings were as follows:

  • The practice dispensed medicines for patients on the practice list who did not live near a pharmacy.The practice had standard operating procedures (SOPs) which were regularly reviewed and covered all aspects of the dispensing process (these are written instructions about how to safely dispense medicines). A system was in place to ensure relevant staff had read and understood the SOPs.

  • The practice held stocks of controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse), and had SOPs in place covering all aspects of their management. Controlled drugs were stored in a controlled drugs cupboard, access to them was restricted and the keys were held securely. Previously, full balance checks of controlled drugs had not been recorded. We found staff had carried out regular checks and recorded them on the electronic document management system.

  • Expired and unwanted medicines were disposed of in accordance with waste regulations.

  • We found a new SOP had been introduced to guide staff how to handle uncollected prescriptions. Appropriate arrangements were now in place for the regular checking of uncollected prescriptions. Checks also included ensuring all prescriptions awaiting collection were signed by an appropriate prescriber, however some unsigned prescriptions had not been picked up by the checks.

  • A new checking process had been introduced to ensure Patient Group Directions remained legally valid and fit for use.

  • A “near miss” record (a record of errors that have been identified before medicines have left the dispensary) was in place, allowing the practice to identify trends and patterns in errors and take action to prevent reoccurrence.

  • There were arrangements in place for the recording of significant events involving medicines.

  • A new system had been introduced to track the use of blank prescriptions since our last inspection. However, the system of recording was not fit for purpose, and staff could not accurately account for the prescriptions on the premises on the day of our visit.

  • The practice had increased the number of identified carers from 0.7% to just over 1%.

  • Infection control issues identified at the last infection had been addressed.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

Review the checking process for prescriptions awaiting collection, in particular to ensure they are signed by an appropriate practitioner

Review the system for recording and tracking blank prescription forms

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

7 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a first announced comprehensive inspection at Tollerton Surgery on 4 December 2014. The overall rating for the practice was good with the key question of safe rated as requires improvement. As a result of our findings at that inspection we issued the provider with a requirement notice for the safe recruitment of staff.

Following the inspection on the 4 December 2014 the practice sent us an action plan that explained what action they would take to meet the regulation in relation to the breach of regulation we identified.

We carried out a further comprehensive inspection of Tollerton Surgery on 7 June 2017 to check whether the practice had made the required improvements. Overall the practice remains rated as good but improvements are required and the practice remains requires improvement for the key question of safe. The practice are now following procedure and recruiting staff safely.

Our key findings were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

  • The practice did not always have embedded systems in place to minimise risks to patient safety. For example, arrangements were not always in place to safely manage medicines

  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with skills and knowledge to deliver effective care and treatment.
  • 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. 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 building was small and in need of upgrading to meet the needs of the growing population. The practice had been granted planning permission to build a new purpose built surgery in the village.
  • There have been recent changes in the staffing structure due to unforeseen circumstances. 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:

  • The provider must improve the arrangements for the proper and safe management of medicines to ensure that care and treatment is provided in a safe way for patients.

The provider should:

  • Improve the system for identifying carers so they are offered relevant support if appropriate.

  • Review the process for monitoring the environment and infection control.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

4 December 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tollerton Surgery on 4 December 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for the population groups of older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, people experiencing poor mental health (including people with dementia). It required improvement for providing safe services. Although we have rated the safe domain as requires improvement, there was no evidence that this had impacted on the care of patients in the population groups.

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

  • There were always enough staff on duty to keep patients safe.
  • The GPs and nursing staff were familiar with current best practice guidance, accessing supporting information from the National Institute for Health and Care Excellence (NICE) and from local commissioners.
  • Most patients said all staff were helpful, supportive and caring.
  • The needs of the practice population were understood and systems were in place to address identified needs in the way services were delivered.
  • The practice had a three year business plan in place which set out the practices objectives.

We saw one area of outstanding practice:

  • The practice had admitting rights, along with two other practices, to a local hospital which offered community beds for palliative care and geriatric care admissions. All GPs at the practice carried out ward visits at this hospital which provided continuity of care for patients. They also worked in conjunction with other health care professionals to deliver the services at this hospital.

However, there were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that required pre-employment checks are completed before staff commence work.

The provider should:

  • Ensure that records relating to controlled drugs are appropriately stored and updated in timely way.
  • Ensure that systems are in place to ensure the security of patient records when outside of the practice.
  • Ensure arrangements are in place for the monitoring of all high risk medicines.
  • Ensure that a plan is put in place to address the identified infection control issues, such as inappropriate flooring, loose tiling and damaged work surfaces.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice