Lockstown Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lockstown Practice on 26 September 2016. Overall the practice is rated as requires improvement. There are two surgery locations that form the practice; these consist of the main practice at Gomer Street and the branch practice at Fisher Street. Systems and processes are shared across both sites. During the inspection we visited the main site at Gomer Street and Fisher Street Surgery.

During 2015 Lockstown practice merged with Fisher Street Practice to form on patient list. There was ongoing work and development to bring the two practices together to ensure a consistent approach to care delivery.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Most risks to patients were assessed and well managed. For example, the practice had arrangements in place to respond to major incidents; however, in the absence of some emergency medicines at Fisher Street Surgery the practice had not carried out a risk assessment.
• The practice had some systems, processes and practices in place to keep patients safe and safeguarded from abuse. However, the practice did not demonstrate that appropriate training had taken place.

• The practice did not operate an effective process to ensure specific pre-employment checks and clinicians’ registration with the appropriate professional body were being carried out.

• Patients in receipt of prescriptions for medicines, which required closer monitoring, were not always receiving a review of their treatment in line with prescribing recommendations.

• The systems for managing information received from secondary care were not effective. For example, GPs were not viewing all incoming information such as secondary care letters.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment in most areas. However, the practice did not establish an effective system to ensure that mandatory training as defined by the practice had been completed.
• Data from the national GP patient survey showed patients rated the practice higher than others for some aspects of care. However, there were questions relating to patients involvement in planning and making decisions, which were lower than local and national averages. Patients we spoke with during the inspection said they were involved in their care and decisions about their treatment.
• Although the practice were aware of their Quality and Outcomes’ Framework performance and explored ways to improve identified areas, data published since the inspections showed areas which required further improvements.
• Information about services and how to complain was available and easy to understand. Although there were evidence of Improvements made to the quality of care as a result of complaints and concerns, there were inconsistencies in the following of the complaints process.
• Patients 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 areas where the provider must make improvement are:

• Ensure an effective system is in place to ensure all staff have received the necessary knowledge and training appropriate to their role. For example, staff must receive and complete training as is necessary to enable staff to carry out their duties effectively and the practice must gain assurance that locums have completed training.

• The practice must establish an effective system to ensure the appropriate monitoring of patients in receipt of prescriptions for high risk medicines is being carried out within recommended time frames as part of, and align with, patients’ care and treatment plans.

• Ensure that hospital correspondence are viewed by staff with the appropriate skills and competences to understand the significance; and implement an effective system for ensuring appropriate actions are taken when required.

• Ensure that risks associated with the absence of some emergency medicines are carried out to mitigate risks associated with anticipated emergencies.

• The practice must ensure the proper safe management of prescription stationary and pads to allow for monitoring and tracking through the practice.

The areas where the provider should make improvement are:

• Implement processes aimed at increasing the number of care plans, medicines and face-to-face reviews carried out with patients in receipt of interventions for substance and alcohol dependency.

• Continue to establish effective processes.

• Establish an effective system to ensure appraisals are carried out as part of a regular cycle.

• Review national GP patient survey results and explore effective ways to improve patient satisfaction.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice