Archived: New Longton Surgery

Letter from the Chief Inspector of General Practice

This is a focused desk-top review of evidence supplied by New Longton Surgery, for areas within the key question safe. This review was completed on 1 December 2016.

On review of the documentation provided by the practice, we found the practice had not made sufficient improvement in providing safe services. Overall, the practice is rated as good.

The practice was previously inspected on 26 August 2015. The inspection was a comprehensive inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). At that inspection, the practice was rated ‘good’ overall. However, within the key question safe several areas were identified as ‘requires improvement’. No requirement notices were issued at that time , although the report identified a number of areas where the practice should make improvements.

At the inspection in August 2015 we found that while the practice was visibly clean and tidy, neither infection control nor cleaning audits had been carried out and the practice’s cleaning policy had not been fully implemented, as there were no cleaning schedules stipulating what needed to be cleaned and when. Clinical equipment was calibrated to ensure that it was functioning properly. However, not all electrical appliances on site had been tested as frequently as required to ensure they were safe, for example equipment in reception and the treatment room was due to be tested in January 2015 but we did not see evidence that this had occurred.

Additionally the practice’s recruitment policy had not been fully followed when appointing a new member of staff; the interview had not been documented.

Other issues noted during the inspection included:

• Training around the Mental Capacity Act 2005 had not been accessed by all relevant staff.
• Although some audits had been carried out, we did not see evidence that audits were driving improvement in performance to improve patient outcomes as we were informed these were reflected on personally but not shared within the practice.
• There was no risk assessment relating to reception staff carrying out chaperoning duties and reception staff who acted as chaperones had not received disclosure and barring service checks (DBS) (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).

The practice was not required to supply a formal action plan but did provide documents subsequent to the inspection demonstrating improvement actions carried out. In November 2016, the practice supplied a range of documentation for review.

These included a cleaning schedule, copies of an infection prevention and control audit, an audit on reception completing tasks as requested by GPs, a risk assessment for DBS checks on chaperones and confirmation staff had completed safeguarding training and understood the Mental Capacity Act.

The practice also demonstrated improvement in the other areas identified in the report from August 2015 which did not affect ratings. The evidence provided by the practice for review did not provide assurance that governance arrangements had improved adequately around providing safe care and monitoring and improving the quality of care.

The areas where the practice must make improvement are:

• Provide assurance that the practice recruitment policy will be followed for all recruitment including keeping records of interviews.

• Ensure all electrical equipment is tested for safety in line with guidance and records are kept.

• Ensure the risk assessment for staff who act as chaperones adequately reflects the guidance issued by the General Medical Council and Care Quality Commission and addresses potential risks to patient safety.
• Introduce formal quality improvement procedures including regular two cycle clinical audit of clinical care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice