Craneswater Group Practice

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection at Craneswater Group Practice on 10 November 2016 to follow up on a warning notice.

The location was previously known as Waverley Road Surgery.

Our previous inspection in April 2016 was a comprehensive inspection and we rated the practice inadequate overall.

The full report is on our website. The practice was rated as follows:

Good in Caring and Responsive.

Requires Improvement in Effective.

Inadequate in Safe and Well led.

As a result of the inspection a warning notice was served. The timescale given to comply with the warning notice was 30 September 2016.

The warning notice served related to regulation 17 Health and Social Care Act: Good governance.

The areas which did not meet the regulatory requirements were:

• The registered provider did not have suitable systems in place to assess, monitor and improve the quality and safety of services provided in the carrying on of the regulated activity (including the quality of the experience of service users in receiving those services).
• Systems did not assess, monitor or mitigate risks related to health, safety and welfare of service users.
• Systems and processes for ensuring all staff were suitably trained did not ensure that all staff had the necessary skills and competencies to carry out their role.
• We found there were no systematic processes in place to ensure that practice policies and procedures were appropriately reviewed and updated to ensure their content was current and relevant. This did not enable staff to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Systems for monitoring and reviewing significant incidents did not ensure that learning from these incidents was consistently shared with all relevant staff to improve practice.
• Systems in place to monitor risk were not sufficiently robust to ensure that actions needed to minimize risk were in place. Risks assessments for areas such as fire and infection control had been carried out, but there was a failure to monitor and act on the findings of the assessments.
• Systems in place to monitor the cleanliness of the premises did not sufficiently protect patients from risk of infection.
• We found that emergency boxes did not contain the emergency equipment stated on the list, such as cannulas. We also found that the checking system did not monitor sterile use by dates of some emergency medicines to ensure items were replaced as needed.

At our inspection on 10 November 2016 we found the provider had complied with the warning notice and was now compliant with the regulation 17 as set out in the warning notice.

Our Key findings were:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Risks assessments for areas such as fire and infection control had been carried out, and there was a system to monitor and act on the findings of the assessments.
• Practice policies and procedures were now appropriately reviewed and updated to ensure their content was current and relevant.
• Systems and processes for ensuring all staff were suitably trained had been addressed and the practice had ensured that all staff had the necessary skills and competencies to carry out their role.
• Systems were now in place to monitor the cleanliness of the premises and protect patients from risk of infection.
• There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

We have not reviewed the ratings for the practice as part of this inspection. 

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 Waverley Road Surgery on 12 April 2016. Overall the practice is rated as inadequate.

The practice was created by merging Waverley Road Surgery with Salisbury Road Surgery in April 2015 and with the stated intention of operating as a single organisation. However there was evidence that demonstrated that the leadership had not yet been able to deliver this goal.

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

• The practice told us they aimed to deliver high quality care and good outcomes for patients; we found the delivery of high quality care was not assured by the leadership governance or culture in place.

• Some risks to patients and staff were assessed but were not well managed; action plans were not acted upon. We found shortfalls relating to fire assessments. Infection control action plans were not implemented to deliver safe care.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough to prevent incidents from re-occurring.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received training to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, this was not consistently put into practice. For example, there were gaps in training for safeguarding adults.
• Data showed some patient outcomes were low compared to the national average. Although some audits had been carried out, we saw limited evidence that audits were driving improvements to patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect.
• The practice had a number of policies and procedures to govern activity, but following a merger of practices some were related to one site only and not entirely integrated across the two sites.
• The practice was proactive in identifying carers and had identified about 3% of their patients also had caring responsibilities.
• Information about services and how to complain was available and easy to understand.
• The leadership structure was unclear; however staff told us they felt supported by management.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The provider was aware of the duty of candour; however the systems in place to ensure compliance with the requirements of the duty of candour were not operated consistently.

The areas where the provider must make improvements are:

• Review the governance arrangements of the practice and implement one governance framework which ensures effective assessment and monitoring at both practice locations.

• Ensure there is a systematic process in place so policies and procedures are appropriately reviewed and include up to date information in order to ensure staff carry out their roles in a safe and effective manner.

• Review the system for monitoring and reviewing significant events, to ensure that improvements and learning from these incidents is consistently shared with all relevant staff.

• Ensure all risk assessment recommendations and action plans are implemented for example those identified in the infection control, and fire action plans.

• Ensure that hazardous chemicals are handled safely and Control of Substances Hazardous to Health information is readily available.
• Review the cleaning arrangements of the practice to ensure they are sufficient to maintain appropriate standards of cleanliness and hygiene.

• Provide safeguarding vulnerable adults training to all staff and ensure this is recorded.

In addition the provider should:

• Review all policies and update them when necessary to reflect the changes since the practice merger with another practice in April 2015.

• Review the system for maintaining records of appraisals to demonstrate how staff are developed in line with the practice vision and governance strategy.

• Review arrangements for staff required to be a chaperone to ensure they are trained and have had appropriate checks or risk assessments undertaken.

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