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Reports


Review carried out on 12 July 2019

During an annual regulatory review

We reviewed the information available to us about Victor Street Surgery on 12 July 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 29 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a focused inspection of Victor Street Surgery on 29 July 2016 to check that action had been taken since our previous inspection in April 2015. Overall the practice is rated as good. The practice was good for Effective, Caring, Responsive and Well Led services.

However we found that the practice required improvement in the Safe domain due to breaches of regulations relating to safe delivery of services.

We found that the practice had not ensured recruitment arrangements included all necessary employment checks for all staff. There were no fire and legionella risk assessments. Safeguarding, basic life support and fire safety training needed to be undertaken for relevant staff. The medicine/vaccination refrigerators required servicing and calibration. Prescriptions were not kept securely and only accessible to authorised people and the practice required effective infection prevention and control systems.

We inspected the practice on 29 July 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection of Victor Street Surgery on our website at www.cqc.org.uk

Our key findings for this inspection were as follows:

The provider had made improvements:

  • Action plans had been produced following infection control audits.
  • The practice reviewed its water safety risk assessment in relation to Legionella to ensure that the water supply did not pose a risk to patients, visitors or staff.
  • Recruitment arrangements included all necessary employment checks for all staff had been carried out.
  • Safeguarding, basic life support and fire safety training had been undertaken by relevant staff.
  • New medicine/vaccine refrigerators had been purchased.

The practice is now rated good for Safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 21/04/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Victor Street Surgery on 21 April 2015. Overall the practice is rated as good .

Specifically, we found the practice to be, it was good for providing responsive, effective, caring and well-led and services for older people, people with long term conditions, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health.

It required improvement for providing safe services.

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.
  • Risks to patients were not effectively assessed and monitored. These included recruitment checks, medicines management, staffing, fire safety and infection control.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Most staff 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.
  • A recent survey showed 94% of patients said they had confidence and trust in the GP treating them;
  • 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 areas of practice where the provider needs to make improvements.

Importantly the provider must:

  • Ensure recruitment arrangements include all necessary employment checks for all staff;
  • Carry out fire and legionella risk assessments;
  • Ensure safeguarding, basic life support and fire safety training is undertaken for relevant staff;
  • Service medicine/vaccination refrigerators and calibrate their temperature gauges;
  • Ensure prescriptions are kept securely and only accessible to authorised people; and
  • Identify, manage and monitor effective infection prevention and control systems.

In addition the provider should:

  • Have a consent policy available for staff to refer to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice