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Inspection carried out on 18 June 2019

During an inspection to make sure that the improvements required had been made

We carried out an announced focused inspection at Cowplain Family Practice on 18 June 2019 as part of our inspection programme. This inspection was to look at the breaches to regulations identified from our previous inspection in March 2018 when the practice was rated as good overall but requires improvement in the key question of Safe. This inspection was a follow up on the Safe key question only. Prior to the inspection we undertook an annual regulatory review which indicated no other key questions needed to be inspected.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good for Safe.

We found that:

  • The practice had made improvements to systems and processes to keep patients safe, particularly in the areas identified as requiring improvement at our previous inspection.
  • All staff had now received training suitable to their role specifically in safeguarding children and vulnerable adults.
  • The practice had identified a new lead for oversight of infection prevention and control and had made improvements to the areas raised in the previous report.
  • The practice was recording water temperatures in line with national health and safety guidance, but the practice could not demonstrate how it was responding to temperatures that were out of range.
  • The practice did not have appropriate security measures in place for its prescription stationery.
  • All staff had received fire safety training, but the practice had not identified designated fire marshals.
  • We found the patient group directives had been signed and authorised but there was evidence in a delay in this process from the date of validation to date of authorisation.

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

  • Consider reviewing policies to include reference to patients using online services.
  • Review the process of authorising patient group directives in a timely manner.
  • Review the process for the management of controlled stationery such as blank prescriptions in line with national guidance.

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 carried out on 20 March 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection July 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Cowplain Family Practice on 20 March 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had strong patient participation group (PPG) representation, with 13 members who meet face to face with the practice. They supported the practice during seasonal flu clinics and the practice’s open morning.
  • There was easy access to appointments especially at the Cowplain Family Practice premises due to the open surgery system. Patients attended on the day that their named GP was available and waited for an appointment.
  • Cowplain Family Practice operated personal lists of patients and the GPs reported they knew their patients well and were able to provide good access to their services as a result.
  • The practices percentage for breast and bowel screening rates were above the national average.
  • The practice proactively addressed the concerns of patients regarding their upcoming relocation of the branch site into the main Cowplain premises building by holding an open morning in the premises to answer questions and introduce patients to the new facilities that would soon become available to them. This was well-attended by over 300 patients and comments received in response to the event were largely positive.
  • The practice did not manage all the risks and needed to have clearer systems to manage risk so that safety incidents were less likely to happen. For example there was not access to appropriate personal protective equipment for staff to use on a daily basis; to include non-sterile aprons and nitrile gloves for non-invasive procedures.
  • Not all staff members had received relevant training such as Safeguarding Adults and Children, and Mental Capacity Act 2005 training.
  • Paper documents regarding for patients care had not always been scanned onto patients electronic care record in a timely manner. Documents containing clinical trial details had not been added to electronic patient records.
  • Safety alerts were not being closely monitored so that all alerts were being actioned and closed appropriately.
  • Sharps bins were not maintained in line with general guidance.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

  • Review the practice’s emergency medicines such as the storing of Dexamethasone

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 28 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cowplain Family Practice on 28 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, and caring responsive and well-led services. It also was rated as good for providing services for the following population groups; 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).

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned for.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • 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 practice also worked in collaboration with three other practices to provides medical cover to 10 step-up/down beds in a local care home to enable patients to be cared for in the community and avoid an unnecessary hospital admission.

  • The practice had an easy read translation protocol on which patients were able to point to the national flag of their country to identify which language they spoke.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction. The practice had a very active patient participation group (PPG).
  • The practice had a non-appointment service which meant that patients could note from the website and practice leaflet when their named GP was available and arrive at the practice and sit and wait for an appointment on the day. The practice ensured that their annual patient surveys included a review of the system to ensure this was still the preferred option for patients. The system was designed so that GPs were able to deal with all patient issues that occur on the day. Emergency appointments were also available for those patients which needed them.

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

Importantly the provider should

  • Consider amending the adult safeguarding policy to include details of frequency of training for staff.
  • Consider including confidentiality clauses within contracts of employment, although there is such a clause in the staff handbook which is contractually binding.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice