Swineshead Medical Group

We had previously carried out an announced comprehensive inspection at Swineshead Medical Group on 12 February 2019. At that inspection we rated the practice as inadequate in safe, requires improvement in effective and well led and good in caring and responsive. The practice was rated as requires improvement overall. The overall rating for the practice was requires improvement. The full comprehensive report on that inspection can be found by selecting the ‘all reports’ link for Swineshead Medical Group on our website at www.cqc.org.uk.

At that inspection we identified breaches of Regulation 12 (Safe care and treatment) and 17 ( Good Governance) of the Health and Social Care Act and issued the practice with a Warning Notice. A follow up inspection was carried out on 25 April 2019 that confirmed that practice was now meeting the legal requirements in in relation to the breaches of the regulations.

This inspection was an announced comprehensive inspection, carried out on 25 July 2019.

Our key findings from this inspection were;

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• 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.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was strong emphasis on audit as means of assessing, measuring and improving outcomes for patients.

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

We had previously carried out an announced comprehensive inspection at Swineshead Medical Group on 12 February 2019.

At that inspection we rated the practice as inadequate in safe, requires improvement in effective and well led and good in caring and responsive. The practice was rated as requires improvement overall.

At that inspection we found;

• There was no assurance that the prescribing of medicines to some patients kept them safe.
• There were no records kept of dispensing errors and near-misses.
• The practice was not assured of the competence of their dispensary staff as no annual competency checks had been carried out’
• Dispensary standard operation procedures had not been signed by dispensers.
• Blank prescription stationary was not monitored effectively or stored securely.
• Equipment that may be needed in a medical emergency was not checked frequently enough to assure its efficacy.
• The temperature of some fridges used to store medicines were not recorded at least daily.
• Not all staff had not completed the practices mandatory training.
• There had been no audit of surgical procedures carried out at the practice

Because of our findings we served the practice with Warning Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The full comprehensive report on the February 2019 inspection can be found by selecting the ‘all reports’ link for Swineshead Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 April 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 12 February 2019. This report covers our findings in relation to those requirements.

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Our key findings were as follows:

• The practice has reviewed and revised its process for ensuring that prescribing was safe.
• A log had been introduced for dispensary errors and near-misses.
• Dispensers competencies had been assessed and completed.
• Dispensary standing operating procedures had all been signed by dispensers.
• Blank prescription stationary was secured.
• There was frequent checking of equipment intended for use in a clinical emergency.
• Fridge temperatures were recorded daily.
• Staff training for the providers essential training was at 100% compliance.
• A system of audit and control had been implemented to provide assurance of surgical procedures.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Swineshead Medical Group on 12 February 2019. This was as part of our inspection program.

Our judgement of the quality of care at this service is based 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.

This practice is rated as requires improvement overall. (At our previous inspection on 28 July 2015 we rated the practice as good)

We rated all the population groups as requires improvement as the areas of concern affected all of the population groups.

We rated the practice as inadequate for providing safe services because:

• There was no assurance that the prescribing of medicines to some patients kept them safe.
• The process intended to safeguard children was not effective.
• The system for learning from serious adverse events was not effective.
• There were no records kept of dispensing errors and near-misses.
• The practice was not assured of the competence of their dispensary staff as no annual competency checks had been carried out’
• Dispensary standard operation procedures had not been signed by dispensers.
• Blank prescription stationary was not monitored effectively or stored securely.
• There was a back-log of 191 sets of new patient notes that had not been summarised.
• Equipment that may be needed in a medical emergency was not checked frequently enough to assure its efficacy.
• The temperature of some fridges used to store medicines were not recorded at least daily.

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

• Not all staff had not completed the practices mandatory training.
• There had been no audit of surgical procedures carried out at the practice

We rated the practice as good for providing caring services.

We rated the practice as good for providing a responsive service.

We rated the practice as requires improvement for providing well-led services because:

• There were not effective systems to support good governance and management.
• The practice did not always have clear and effective processes for managing risks.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care