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Inspection Summary

Overall summary & rating


Updated 9 January 2020

We carried out an announced focussed inspection at Litcham Health Centre on 14 November 2019 to follow up on breaches of regulations identified at a previous inspection in November 2018.

At the last inspection in November 2018 we rated the practice as requires improvement for providing safe services because:

  • The practice did not have appropriate systems in place for the safe management of medicines.
  • The practice did not have effective infection prevention and control systems and processes in place.

At this inspection we rated the practice as Good for providing safe services because sufficient improvements had been made since our last inspection including:

  • Introducing a system of more frequent checks for emergency medicines and equipment and a protocol for managing out of date medicines.
  • Introducing a new standard operating procedure for managing the cleaning of equipment, supported by cleaning schedules and regular reviews.

We also reviewed additional areas identified in our previous inspection where the practice could improve and found:

  • The practice had reviewed and improved their identification and recording of patients who were carers through patient registration forms and clinical reviews, for example identifying carers of patients with dementia. The practice had identified 37 patients who were carers, representing 1% of the practice population. The practice had a dedicated member of staff who identified and provided support for carers including information about local support services.
  • The practice had carried out a number of antibiotic prescribing audits and had identified areas for improvement, however action plans and further audit cycles were required to demonstrate improved antibiotic prescribing rates. 
  • The practice had provided training for non-clinical staff in identifying deteriorating or acutely unwell patient’s suffering from potential illnesses such as sepsis. Reception staff we spoke with confirmed appropriate signs and symptoms they would look for and appropriate systems for raising concerns with a clinician.
  • The practice had carried out a detailed risk assessment and had put in place mitigating actions to reduce or remove identified risks for each of the remote collection points used for medicines dispensed by the practice. Actions included improving the recording of who was collecting medicines and making regular visits to each site to assess security risks.  
  • The practice had reviewed how standard operating procedures (SOP) were implemented in the dispensary and demonstrated how staff had signed up to work within each SOP and how their compliance was monitored, including through call audits.
  • The practice had reviewed their system for ensuring staff received regular appraisals and since the last inspection had scheduled all staff for an appraisal. Staff we spoke with confirmed they had had an appraisal and valued the experience as an opportunity to discuss performance, development opportunities and learning needs. Staff also used the opportunity to discuss concerns and issues where required, however felt they could approach management at any time to discuss problems.

Whilst we found no breaches of regulations, the provider should:

  • Continue to review and improve antibiotic prescribing rates.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas










Checks on specific services

People with long term conditions


Families, children and young people


Older people


Working age people (including those recently retired and students)


People experiencing poor mental health (including people with dementia)


People whose circumstances may make them vulnerable