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Dr Christopher Cole and Partners Good Also known as The Red and Green Practice

Reports


Inspection carried out on 26 Aug 2020

During an inspection looking at part of the service

We previously carried out an announced focused inspection at Dr Christopher Cole and Partners, on 28 January 2020 as part of our inspection programme to follow up on concerns and breaches of regulations following our previous inspection in December 2018. We rated the practice as Good overall, however we found a breach of regulations and rated the key area of Safe provision of services as Requires Improvement. You can read the full report by selecting the ‘all reports’ link for Dr Christopher Cole and Partners on our website at .

We were mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate, this was therefore a desk-based review. On 26 August 2020, we commenced the desk-based review to confirm that the practice had carried out its plan to meet the legal requirements in relation to the breach of regulations that we identified at our previous inspection in January 2020.

We found that the practice is now meeting those requirements and we have amended the rating for this practice accordingly. The practice is now rated Good for the provision of Safe services. We previously rated the practice as Good for providing Effective, Caring, Responsive and Well-Led services.

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

  • what we found when we reviewed the information sent to us by the provider
  • information from our ongoing monitoring of data about services and
  • information from the provider.

We have rated Safe as Good because:

  • The practice had identified and completed actions, in response areas identified as requiring improvement at our previous inspection in January 2020.
  • The practice demonstrated it had revised its Disclosure & Barring Service (DBS) procedures. We reviewed an associated risk assessment that the practice had completed for a staff member who had started employment prior to their DBS being confirmed.
  • The practice demonstrated it had revised recruitment processes, and had identified a dedicated staff member responsible for the checking identification documents, to ensure incoming staff member details were correct.
  • The practice demonstrated it had improved its security and monitoring processes of blank prescription stationery. This included comprehensive documentation of blank prescription scripts in line with national guidance, and the removal of all but two centralised printers within the practice’s sites, where blank prescription stationery was used.
  • The practice provided data to show it had increased the usage of the Electronic Prescription Service (EPS) since July 2018 from 87% to 97% by July 2020, which indicated less reliance on paper prescriptions being issued at the practice.

Although not part of the practice’s previous regulatory breach, the practice demonstrated it had also made improvements since our last inspection which included:

  • Producing a comprehensive risk assessment for its staff regarding their vaccination status.
  • Completing a hand-hygiene audit with a random selection of staff to ensure appropriate hand-hygiene measures were in place and staff were compliant with the requirements expected by the practice.
  • Identifying learning from an incident involving unpacked vaccines found at our previous inspection. The practice provided copies of delivery audit forms and vaccine stock checks to demonstrate that no further such incidences had occurred.

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 28 Jan 2020

During a routine inspection

We carried out an announced comprehensive inspection at Dr Christopher Cole and Partners on 28 January 2020 as part of our inspection programme to follow up on concerns and breaches of regulations following our previous inspections in December 2018 and November 2017.

At the last inspection, on 20 December 2018, we rated the practice as Requires Improvement overall. Specifically, we rated the practice as Requires Improvement for providing safe and well-led services. We issued a Requirement Notice for Regulation 17: Good Governance.

At this inspection, on 28 January 2020 we found that the provider had adequately addressed our previous concerns but new concerns were identified.

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 overall but we have continued to rate the practice as Requires Improvement for providing safe services. We have rated this practice as good for all population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm. However, that did not include the mitigation of risk relating to the completion of Disclosure and Barring Service checks, staff name changes, nor prescription stationery security when in use.
  • The practice had improved its processes around the clinical supervision and monitoring of prescribing practices of its staff employed in advanced clinical roles.
  • Patients received effective care and treatment that met their needs.
  • The practice had revised its annual recall and exception reporting systems to the extent that an increase in patient uptake and a lowering of exception reporting figures had been demonstrated.
  • The practice had a dedicated training officer to support staff in accessing and completing the expected training requirements set by the practice.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice had increased its number of patients who also identified as carers and offered appropriate support according to their needs.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The practice had supported and facilitated new incentives to support its patients. For example, the creation of a garden in the practice grounds, which patients could visit, as well as get involved with, to support their physical and mental well-being, and a bereavement support group.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • Governance arrangements had not ensured appropriate oversight was in place in relation to adequate vaccine stock control, monitoring of blank prescription stationery, appropriate staff recruitment checks, and the completion of Disclosure and Barring Service checks.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Continue to improve patient satisfaction in relation to continuity of care.
  • Continue to lower exception reporting rates.
  • Seek assurances that staff are following correct procedures relating to infection control and prevention, for example, hand hygiene.
  • Revise how stock control measures are carried out to mitigate the risk of vaccines not being unpacked in a timely manner.

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 Dec 2018

During a routine inspection

We carried out an announced comprehensive inspection at Dr Christopher Cole and Partners on 20 December 2018.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 28 November 2017.

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 requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

  • The practice did not always follow their systems and processes which kept people safe and safeguarded from abuse.
  • The practice did not consistently follow actions identified in their fire risk assessment.
  • Infection prevention and control processes were not fully embedded.
  • The safety and efficacy of medicines requiring refrigeration could not be assured.
  • The practice could not demonstrate the prescribing competence of non-medical prescribers. While the practice had made some improvements since our inspection on 28 November 2017, it had not appropriately addressed the requirement notice in relation to ensuring that all staff had received training in line with practice policy.

We rated the practice as

good

for providing effective, caring and responsive services because:

  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We rated the practice as

requires improvement

for providing well-led services because:

  • The practice did not have clear processes for managing the performance of clinical staff.
  • The practice’s arrangements for identifying, managing and mitigating risks were not always embedded
  • Policies were not consistently embedded, for example in relation to controlled drugs.
  • Not all staff felt that leaders were visible and approachable.
  • The practice did not maintain oversight of necessary training for GPs.

The areas where the provider

must

make improvements are:

  • Assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Continue to improve uptake of cervical screening.
  • Continue efforts to identify patients who are carers.
  • Continue to use patient feedback to help drive improvements.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 28 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection November 2014 – Good)

The key questions are rated as:

Are services safe? - Good

Are services effective? - Requires Improvement

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 - Requires Improvement

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 Dr Christopher Cole and Partners on 28 November 2017. This inspection was part of our inspection programme. We visited both main site and the branch location.

At this inspection we found:

  • 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.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • Medicines and Healthcare products Regulatory Agency alerts were said to be acted upon but this was not recorded.
  • The practice gave us verbal assurances that they conducted regular reviews of their policies however this was only evidenced if changes were made to the policy. The practice could not evidence when a policy had been reviewed and no changes were made.
  • Not all patients with long term conditions had their health and care needs checked on a regular basis.
  • Not all staff had received mandatory training in line with practice policy such as for Information Governance and Mental Capacity Act 2005
  • There was a focus on continuous learning and improvement at all levels of the organisation.

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

Importantly, the provider must;

  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The area the provider should make improvements:

  • Review feedback from patients such as information gathered by national bodies including the GP patient survey.
  • Improve the system for recording when policies are reviewed but not changed.
  • Improve the process for the recording of action taken in response to managing and acting on Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
  • Review the process for patients with long term conditions have a regular review of their health and care needs.
  • Have a clear programme of quality improvement such as through audit.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 5 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection on 5 November 2014. During our visit we inspected the services provided from Waterside Health Centre, we did not visit the branch surgery at Blackfield Health Centre. The practice provides training for GP registrars and medical students.

Overall the practice provided a good service for patients.

Our key findings were as follows:

  • Patients were able to access same day appointments.
  • Patients were treated with dignity and respect and involved in their treatment.
  • Each patient had a named GP to promote individualised care.
  • Infection control processes were robust and minimised the risk of cross infection.
  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. We found details of the vision and practice values were incorporated in the day to day running of the practice.
  • The practice had robust systems in place to ensure there were always sufficient staff to provide the service; this included forward planning to cover annual leave requirements.
  • Patients benefited from an active approach of the practices’ involvement with a separate organisation of 17 GP practices. For example a new phlebotomy service was due to commence in January 2015.

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

The provider should

  • The practice should ensure that all staff have relevant safeguarding training for adults as well as children appropriate to their role.

We carried out a comprehensive inspection on 5 November 2014. During our visit we inspected the services provided from Waterside Health Centre, we did not visit the branch surgery at Blackfield Health Centre. The practice provides training for GP registrars and medical students.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice