Dr Asad Hussain Also known as Ribble Village Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Asad Hussain (Ribble Village Surgery) on 24 November 2016. The overall rating for the practice was requires improvement with the key questions of safe and well-led rated as requires improvement. The full comprehensive report on the November 2016 inspection can be found on our website at http://www.cqc.org.uk/location/1-543199771

This inspection was an announced focused inspection carried out on 19 July 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 24 November 2016. 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:

• At our previous inspection in November 2016, we saw that reviews and investigations of significant incidents were not thorough enough and did not include actions taken to mitigate the risk. We also saw that there was a lack of staff knowledge of their role and responsibility in sharing information regarding specific types of incidents. At this inspection, we saw that there was a comprehensive system in place for reporting and recording significant events. Staff were clear about what constituted a significant event. Actions taken as a result of significant events were reviewed in a timely way and learning from events was shared.
• At our inspection in November 2016, we saw that there was a lack of effective systems in place to manage patient safety alerts. At this inspection we saw that a new system was in place to ensure that actions taken as a result of these alerts were reviewed and shared appropriately. Minutes of discussion of these were kept for staff.
• During our previous inspection we saw that although patient safeguarding concerns were discussed between the practice and other stakeholders and agencies, these discussions were not recorded and information relating to them not entered onto the patient computerised record. At this inspection, we saw that minutes of meetings with other stakeholders were kept and details of discussion entered onto patient records. Processes had also been put in place to ensure that this happened.
• At our inspection in November 2016 we observed that equipment and furniture in one clinical area was not hygienically clean. There was a lack of infection prevention and control audit for the surgery environment. We found at this inspection that this had been addressed and that all areas of the practice were suitably clean and subject to spot checks and audit.
• At our previous inspection we saw that there was no stock control system in place for the management of vaccines, no effective monitoring of patient requests for controlled drugs and no monitoring system in place for patient uncollected prescriptions. At this inspection, we saw evidence that safe systems had been put in place and maintained to address these areas effectively.
• During our inspection in November 2016, we found that there was a lack of an effective call and recall system for patients with long-term conditions. At this inspection we saw that the practice had purchased software and introduced a procedure of patient call and recall to enable them to do this effectively.
• At our previous inspection we identified that the governance of practice policies and procedures was insufficient. We saw at this inspection that the practice had introduced a system of regular review of policies and procedures to ensure that all were current and based on best practice.

The practice had used the findings from our inspection in November 2016 to review many of the systems and processes in place to ensure that they reflected best practice and we saw evidence of this. Evidence that we saw included:

• The practice had improved its appraisal system for staff to include a mentoring system, in particular in relation to new staff.
• The security and confidentiality of patient-identifiable information had been improved.
• All staff at the practice had been subject to a disclosure and barring service (DBS) check. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Mandatory “Prevent” training had been introduced to supplement staff safeguarding training. (This training safeguards vulnerable people from being radicalised to supporting terrorism or becoming terrorists themselves). A new safeguarding folder had been produced which included training resources including a policy explaining practice responsibilities for providing care and treatment for military veterans.
• The practice had developed a new business plan and introduced a regular review of developments in relation to the plan.
• All staff were required to undertake chaperone training annually and it was part of mandatory training for new staff.
• The practice had introduced a new clinical audit policy to develop a comprehensive quality improvement programme that was embedded into all aspects of service delivery. They had reviewed the results of the national GP patient survey and produced an action plan to improve services.
• A new standard operating procedure (SOP) file had been produced setting out many of the practice procedures and was used to inform and train new staff. There was a new comprehensive staff checklist for all aspects of administration daily tasks to ensure that they were completed.
• The practice had reviewed the process by which patients were excluded from the Quality and Outcomes Framework (QOF). (QOF measures practice performance against national screening programmes to monitor outcomes for patients). We saw unverified evidence at the time of the inspection that the patient exclusion rate was 2.6% overall compared to 10% in 2015/16.
• The practice had produced a new policy for managing patient complaints and resources for patients to tell them how they could complain, and for staff to deal with complaints effectively.
• There was an overview held of practice staff clinical indemnity which enabled safe management of clinicians’ practice insurance.
• There was a programme of well-documented meetings in place which included all members of staff. Minutes of meetings were available to staff and were comprehensive, to evidence and share learning.
• The practice had employed a female locum GP to provide GP services for patients for one surgery each month.
• The practice had developed several presentations to use for a dementia awareness day that they were planning to run for patients during August 2017. They told us that they also hoped to use these resources to train staff at a local care home in the management of patients with dementia.
• Since our last inspection in November 2016, the practice had continued to develop facilities to become a training practice for GPs in training. This had been approved in June 2017 and the practice hoped to start training in August 2017.

We saw one area of outstanding practice:

• The practice had received four awards from the local clinical commissioning group (CCG) related to patient ‘flu vaccinations given during the winter of 2016/17. These were for being the highest achieving practice in the Preston CCG for giving ‘flu vaccinations to healthy children aged two years and over, aged three years and over, children aged four years and over and for all patients from six months old to 65 years of age who were in a patient clinical risk group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice