Robert Frew Medical Partners

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Robert Frew Medical Partners on 28 September 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• There was a system in place for reporting and recording significant events. However improvements were required for the provider to comply with the requirements of the duty of candour. Not all staff were clear what constituted incidents. Some incidents lacked investigations and evidence of learning to mitigate their reoccurrence.
• Medicine alert information had not been consistently actioned and some patients were found to be on medicines contrary to guidance and reviews of medicines. The practice was unable to demonstrate that high risk medicines had been appropriately monitored or patient records sufficiently endorsed to demonstrate safe prescribing.
• Safeguarding arrangements were not sufficiently established to enable clinicians to identify those patients potentially at risk. The practice was not following up on vulnerable persons who had attended accident and emergency services or their hospital appointments.
• The practice was clean and tidy. However, the lead infection prevention control nurse had not received appropriate training. Cleaning schedules were not sufficiently detailed to evidence where, when and how surgical facilities had been cleaned. They had identified the practice to be 68% compliant but we found no action plan to support the areas requiring improvement.
• The practice were not monitoring or recording the issue of prescription stationery within the practice.
• Staff had undertaken appropriate recruitment checks including disclosure and baring service checks.
• Risk assessments for health and safety, fire and legionella were in place. However, not all electrical safety checks were in place as required by health and safety legislation.

• The practice had a defibrillator available at the main practice site. The practice had considered emergency arrangements at their branch surgery, these were not documented. Some medicines and medical supplies were out of date at the main practice.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable or above average compared to the local and national averages.

• The practice performance for patient participation in national cancer screening and vaccination programmes was in line with local and national averages.
• Patient blood results had not been consistently reviewed and actioned in a timely and appropriate manner.
• There was no locum induction pack in place for GPs.
• Data from the national GP patient survey, published in July 2016 showed patients rated the practice comparable or above the local and national average for the service they received from the practice nursing team.
• Where low levels of satisfaction were reported with the GPs the practice had shared their findings with their patient participation group and agreed to undertake individual performance reviews in order to improve service delivery.
• The practice had identified carers and was working in partnership with social care professional to provide a drop-in advice service to patients.
• Patients told us they were able to get appointments. However, the practice had not actively addressed the high non-attendance rates by some patients.
• The practice had responded to concerns raised by their patients relating to the accessibility of the service, introducing new systems in partnership with their patient participation group.
• Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.
• There was a governance framework in place. The partners met regularly to monitor and improve the quality of the service. However, the practice did not review overall performance.
• The practice needed to broaden their assessments of risks to include the management of abusive patients and removal of out of date and redundant medical supplies.
• The practice proactively sought feedback from patients, which it acted on. The patient participation group was active and told us the partners involved them and operated with transparency.

The areas where the provider must make improvements are:

• Ensure staff have the knowledge and understanding to improve the recognition of incidents and there is an effective system in place for managing significant events and safety incidents. Ensure these are investigated thoroughly and learning identified, disseminated and embedded into practice.
• Implement an effective system for the consistent and timely actioning of information (such as patient medicine alerts, patient clinical results and conducting reviews of patients prescribed high risk medicines).
• Ensure that systems and processes are in place for the management of infection control and staff with lead roles have access to the necessary knowledge and understanding to undertake the role.
• Ensure that an effective system is in place to regularly assess and monitor practice performance.
• Monitor and review patient attendance at accident and emergency to identify where there may be a safeguarding risk to patients.

In addition the provider should:

• Act on patient feedback in relation to the satisfaction rates to improve patient experience of the service and the performance of the GPs.

• Implement a system to monitor and track the issue of prescriptions throughout the practice.

• Review non-attendance rates by patients in order to improve the management of clinical capacity.
• Have a system in place for the induction of locums into the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice