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Inspection Summary


Overall summary & rating

Good

Updated 5 September 2018

At our previous comprehensive inspection at Balmore Park Surgery in Caversham, Berkshire in November 2017 we found a breach of regulations relating to the management of risks, specifically risks associated with the management of medicines, recruitment and health and safety.

Although the overall rating for the practice was good, the practice was rated requires improvement for the provision of safe services. The practice was rated good for the provision of effective, caring, responsive and well-led services. In addition, all population groups were also rated good.

The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Balmore Park Surgery on our website at www.cqc.org.uk. This inspection was an announced focused inspection carried out on 29 August 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in November 2017. This report covers our findings in relation to those requirements and improvements made since our last inspection. We found the practice had made improvements since our last inspection.

At our inspection on the 29 August 2018 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. The overall rating remains good.

Our key findings were as follows:

  • Systems had been implemented and embedded which ensured care and treatment was provided in a safe way to patients.
  • The practice had established and was now operating safe and effective systems to assess, manage and mitigate the risks associated with the management of medicines, recruitment and health and safety.
  • There was greater awareness and documented assessments which identified and reviewed individual staff health needs and we saw reasonable adjustments were made, where necessary.
  • There was an improved process which tracked and monitored the usage of prescription stationary including blank prescriptions.
  • Practice staff had attended additional training specific to their roles, this included training on sepsis. Sepsis is a rare but serious complication of an infection.

  • The practice had improved the arrangements to support patients with learning disabilities. Specifically, the number of patients who had an annual health check had increased from 54% in November 2017, to 80% in August 2018.

  • The practice had revised and reviewed the policies and procedures in place to govern activity and support the safe running of the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 September 2018

At our previous inspection in November 2017, we rated the practice as requires improvement for providing safe services as we identified concerns relating to the management of medicines, recruitment and health and safety.

These arrangements had improved when we undertook a follow up inspection on 29 August 2018. The practice is now rated as good for providing safe services.

Risks to patients

The practice had reviewed and strengthened existing arrangements to assess, monitor and manage risks to patient safety.

  • Disclosure and Barring Service (DBS) checks were undertaken for all clinical staff and the Practice Manager. (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). Risk assessments had been completed for non-clinical members of staff who did not have a DBS check. The risk assessments identified there were occasions when reception staff worked on their own with patients during enhanced hours including Saturday mornings. As a result, all the reception staff who worked during the enhanced hours period had a completed DBS check appropriate to their role. Furthermore, we saw this amended process had been added to the recruitment check list for all non-clinical staff.

  • We saw evidence that a risk assessment process has been established and all managers have been trained in how to use the process. This process included detailed, clearly documented risk assessments which were all recorded in a central file.

Safe and appropriate use of medicines

The practice had embedded improved systems and processes for handling medicines. These systems were monitored by the in-house clinical pharmacist and aligned to national medicines guidance.

  • A risk assessment was conducted and on review it was agreed by the GP’s and pharmacist that there was no further need for Controlled Drugs (CDs) to be kept on site (CDs are medicines that require extra checks and special storage because of their potential misuse). We saw evidence that the CDs were destroyed by the pharmacist according to the Destruction of Controlled Drugs Protocol. We also saw the pharmacist had created a directory of pharmacies in the local area that held CDs for the GP’s information.

  • The practice had reviewed and assessed the supply and storage of medicines they held to manage medical emergencies. This review identified the different types of medicines the practice held. A GP led meeting was held which reviewed the stock of emergency medicines and rational of appropriate medicines to be held in different locations throughout the practice, for example what was held in treatment rooms and what was held in emergency ‘grab bags’. The practice completed six monthly risk assessments to ensure these arrangements reflected national guidance.

  • We saw evidence that all staff who administered medicines to patients and gave advice on medicines was now in line with legal requirements and current national guidance. The Patient Group Directions (PGDs) process has been reviewed in conjunction with the pharmacist and shared with nursing team in the Nurse Team Meeting. (Patient Group Directions are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment). At the August 2018 inspection we saw nurses only work under PGD when all paperwork was completed to ensure safety and professionalism when administering immunisations. Similar to the PGD review, the Patient Specific Directions (PSDs) process had been reviewed. Patient Specific Directions are written instructions, from a qualified and registered prescriber for a medicine including the dose, route and frequency or appliance to be supplied or administered to a named patient after the prescriber has assessed the patient on an individual basis). The process was shared with the nursing team including the health care assistants, this also included a full team briefing on individual responsibilities towards PSDs. Staff we spoke with at the August 2018 inspection had a comprehensive understanding on the differences between PGDs and PSDs and administration of vaccines and medicines.

These actions were now ensuring that requirements relating to safe care and treatment were being met.

Please refer to the Evidence Tables for further information.

Effective

Good

Caring

Good

Responsive

Good

Well-led

Good
Checks on specific services

People with long term conditions

Good

Updated 23 January 2018

Families, children and young people

Good

Updated 23 January 2018

Older people

Good

Updated 23 January 2018

Working age people (including those recently retired and students)

Good

Updated 23 January 2018

People experiencing poor mental health (including people with dementia)

Good

Updated 23 January 2018

People whose circumstances may make them vulnerable

Good

Updated 23 January 2018