• Doctor
  • GP practice

Archived: Beech House, Shebbear Surgery

Overall: Inadequate read more about inspection ratings

Beech House, Shebbear, Beaworthy, Devon, EX21 5RU (01409) 281221

Provided and run by:
Beech House, Shebbear Surgery

All Inspections

30 January 2018

During a routine inspection

The LMC, CCG and NHS(E) have supported the practice following previous inspections and the practice had shown signs of improvement. Recently there have been whistleblowers, plus other concerns raised by healthcare professionals resulting in our planned focussed inspection being changed to a comprehensive inspection. Since the current inspection ended the practice has been working with NHS(E) to manage their contract.

This practice is rated as Inadequate overall. (Previous inspection February 2017 – Good overall).

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

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 – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

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

We carried out an announced comprehensive inspection at Beech House, Shebbear Surgery on Tuesday 30 January 2018. The purpose was to follow up concerns about the leadership at the practice received in January 2018.

At this inspection we found:

  • Care and treatment was delivered according to evidence- based guidelines.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical staff had been trained to provide patients with effective care and treatment.
  • Patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care now that the locum GPs were more regularly employed.
  • The Hatherleigh practice ran an open surgery daily between 9am and 10.30am and between 4pm and 5pm whereby patients were able to walk in and wait to see a nurse or GP without a pre booked appointment and the patients of Beech House could also benefit from this service.
  • The practice held a three monthly diabetic outreach clinic where patients with complex diabetes could be reviewed by the visiting diabetic team from the Royal Devon and Exeter Hospital.
  • The service offered a ‘Market clinic’ in Hatherleigh where staff from the practice held an open surgery in the market once a year where anybody, including patients not on the practice registered list, could come and have blood pressure, blood glucose and any health queries checked. The practice staff then gave a report to take to the patient’s own practice.

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; for example, ensure systems are established and maintained for the proper and safe management of medicines, including ensuring; safe systems were in place for issuing private prescriptions for controlled drugs. Repeat prescriptions were not always signed before being dispensed to patients and there was not a reliable process to ensure this occurred.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care; for example, by ensuring; failsafe processes are in place for managing medicine alerts to ensure patient safety; systems are established and maintained to assess monitor and mitigate the risks associated with patient safety, staff employment, staff training, policies and procedures and management of significant events and feedback from staff; staff receive appropriate support, training and appraisal to carry out their duties and levels of leadership and and governance adequately facilitate safe, effective and well-led services for patinets and staff, considering the geography of the locations coupled with the clinical commitments of the partners and recent change in GP cover.

The areas where the provider should make improvements include:

  • Policies are reviewed to provide current best practice guidance for staff
  • Employment records show suitable medical defence cover and current registration with professional bodies before staff are employed
  • Records for significant events clearly show staff involvement, learning points and actions taken.
  • Communication with healthcare professionals is maintained during periods of staff shortages
  • Systems are in place to ensure any medicines within doctors bags are within expiry date
  • Staff have opportunities to attend meetings and are supported to give feedback

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 FRCGPChief Inspector of General Practice

21 March 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out this announced comprehensive inspection at Beech House Shebbear Surgery on 23 February 2017. This was following a comprehensive inspection in July 2015 where the practice did not have safe systems in place for the safe management and storage of medicines. We also performed a focused follow up inspection in December 2016 to look at steps they had taken to meet their breach of regulation. We did not rate the practice following the December 2016 inspection but issued two Warning Notices, one for safe management and storage of medicines and the second for governance. We carried out a focused inspection for these Warning Notices on 21 March 2017. The full comprehensive report for July 2015 and focussed follow up inspection in December 2016 can be found by selecting the ‘all reports’ link for Beech House Shebbear Surgery on our website at www.cqc.org.uk .

Following the February and March 2017 inspections we found improvements had been made and the Warning Notices were fully met. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had systems in place to minimise risks to patient safety.
  • Medicines were effectively managed.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with 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 practice had good facilities and was well equipped to treat patients and meet their needs. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place which ensured the cleanliness of the practice was maintained to a high standard.
  • There were systems and processes in place to ensure the oversight and governance of the practice was maintained.
  • 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

13 December 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an inspection of Beech House, Shebbear Surgery on 13 December 2016. This review was performed to check on the progress of actions taken following an inspection we made in July 2015. In July 2015 the practice did not have safe systems in place for the safe management and storage of medicines. We requested an action plan following the inspection in May 2015 which detailed the steps they would take to meet their breach of regulation.

The practice has not been rated following this inspection. A comprehensive inspection is planned for the near future.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published in October 2015. This can be done by selecting the 'all reports' link for Beech House, Shebbear Surgery on our website at www.cqc.org.uk

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

During our latest inspection on 13 December 2016 we found the provider had started to make the necessary improvements with medicines management within the dispensary.

  • Systems were in place to ensure all prescriptions, including those for controlled drugs were signed before they were dispensed to the patient.

  • Systems were in place to monitor patients that were taking high risk medicines.

  • All staff dispensing medicines had commenced or received appropriate training.

  • Systems were in place to record the balance of controlled drugs being received into the dispensary and being dispensed.

However, other aspects of the practice had not improved and were poorer than previously identified.

  • Emergency equipment and medicines were available; however, some of the emergency medicines and many other medicines found in the consulting room were found to be out of date.

  • Minimum and maximum refrigerator temperatures were not being recorded in a timely way as to ensure safe storage of medicines.

  • Medicines were not stored securely, including those returned from patients.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, the documentation was not always in sufficient detail.

  • Blood and urine samples were not sent for testing in a safe time scale.

  • Controlled drugs were not always stored or disposed of in accordance with legislation.

  • Governance arrangements were not effective in providing an oversight of practice performance, patient safety or the performance of staff.

  • Leaders did not have the necessary experience, knowledge, capacity or capability to lead effectively and at times were out of touch with what was happening during day-to-day service delivery.

The areas where the provider must make improvement are:

  • Ensure that all medicines in the practice are in date and stored securely.

  • Ensure that patient returned medicines are stored securely and safely disposed of according to The Hazardous Waste (England and Wales) Regulations 2005.

  • Ensure that controlled drugs are prescribed, dispensed, stored, recorded and disposed of according to The Misuse of Drugs Regulations 2001 and The Misuse of Drugs (Safe Custody) Regulations 1973.

  • Ensure systems and processes are in place to provide effective governance, including quality assurance and auditing systems or processes.

  • Ensure that blank prescription stationary is stored securely at all times and the use of prescriptions monitored in accordance with NHS Protect guidance.

The areas where the provider should make improvements are:

  • Review how competency assessment is considered for dispensary staff

  • Ensure consistent and accurate information is provided regarding opening times and appointment times

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

16 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Shebbear Surgery on 16 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services, but found the practice to require improvement for safe services. It was good for providing services for all the population groups.

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.
  • 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.
  • 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.

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

Importantly, the provider must:

  • Ensure all prescriptions for controlled drugs are signed before they are dispensed to the patient.
  • Ensure systems are in place to monitor patients that are taking high risk medicines.
  • Ensure that the minimum and maximum refrigerator temperatures are recorded to ensure safe storage of medicines.
  • Ensure all staff dispensing medication are suitably trained, and their competency reviewed.
  • Have a system to record the balance of controlled drugs being received into the dispensary and being dispensed.

In addition the provider should:

  • Have systems in place to ensure that medicines used in the case of an emergency are within their expiry date and safe to use.
  • Put systems in place to record the room temperature of the dispensary to ensure medicines are stored safely.
  • To allow for continuity of care from all healthcare professionals, care plans for vulnerable patients living at a care home should be placed on the practice computer system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice