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Inspection carried out on 30 January 2018

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stow Surgery on 6 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Stow Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 30 January 2018 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 6 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

.Overall the practice is now rated as Good.

Our key findings were as follows:

  • Systems and processed had been improved to ensure the risks of infection in the practice were managed appropriately.

  • Arrangements for managing medicines in the practice had been improved to minimise risks to patient safety.

  • Arrangements to deal with emergencies and major incidents have been reviewed and implemented.

  • Systems and processes had been reviewed and implemented to ensure staff had appropriate support, competency assessments, regular appraisal and training.

  • The practice had reviewed their data in relation to patients who had been excluded from reviews and were able to provide assurance that patients were receiving appropriate reviews and monitoring.

  • Systems to ensure that standard operating procedures in the dispensary were up to date and reviewed regularly had been improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 6 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stow Surgery on 6 June 2017. Overall the practice is rated as requires improvement.

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

  • There was an open and transparent approach to safety and a system was in place for reporting and recording significant events.
  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to make an appointment with a named GP, and although sometimes there was a wait, 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 most staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • The practice had a number of policies and procedures, and standard operating procedures to govern activity, but some were overdue a review.

The areas where the provider must make improvement are:

  • Ensure systems and processes are reviewed to ensure safe care and treatment for patients.

  • Ensure arrangements in respect of staff support and training are reviewed.

The areas where the provider should make improvement are:

  • Ensure there is an effective system for the monitoring of staff training and competence.

  • Ensure systems for the security of prescription forms including pads are monitored.

  • Review the systems for ensuring standard operating procedures in the dispensary are current.

  • Ensure the number of patients who had been excluded from reviews are appropriately reviewed and identify ways to improve uptake for these reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on This desk based inspection review did not involve a visit to the practice

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a desk top review of this practice on 3 June 2015 to consider the safe domain following the inspection on 4th November 2014 with information provided following that inspection. The current rating is overall good however the safe domain required improvement in relation to the storage, dispensing and administration of medicines, the fabric of the building and infection control, contact information for safeguarding children and vulnerable adults, access to the premises and audits. There were no breaches of regulation but we said they weren’t safe enough.

Drs Healy, Thornett and Sherringham (also known as Stow Surgery) is a semi-rural dispensing practice providing primary care services to patients resident in Stow-on-the-Wold and the surrounding villages from Monday to Friday. The practice has a patient population of 5,500 of which 28% are over 65 years of age. The practice supports training for medical students and doctors specialising in general medical practice.

We undertook a scheduled, announced inspection on 4th November 2014. The overall rating for the practice was good. Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for older patients, those with long term conditions and families, children and young patients. In addition it was good for providing services for working age patients, those whose circumstances made them vulnerable and people experiencing poor mental health including those living with dementia.

When we reviewed the information supplied by the provider we found they had responded appropriately to the things they should address and improvements had been made so services were now safe for patients, staff and visitors to the practice. However, the rating for Safe will not change until the next comprehensive inspection.

  • The provider had undertaken a risk assessment and developed updated standard operating procedures for the storage, dispensing and administration of medicines such as patient group directions and the use of liquid nitrogen.

  • Repaired the fabric of the building to aid cleaning and reduce the risk of infection.
  • Improved systems to monitor the cleanliness of the building.

  • Improved access for patients with mobility needs.

  • Developed a schedule of regular clinical audit cycles to demonstrate organisational learning and improved patient care
  • Improved availability of information to staff for agencies to contact when there were concerns about patients at risk of abuse.
  • Improved systems to audit minor surgery including the follow up of patients test results.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 4 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

Drs Healy, Thornett and Sherringham (also known as Stow Surgery) is a semi-rural dispensing practice providing primary care services to patients resident in Stow-on-the-Wold and the surrounding villages from Monday to Friday. The practice has a patient population of 5,500 of which 28% are over 65 years of age. The practice supports training for medical students and doctors specialising in general medical practice. It is also a practice which participates in medical research.

We undertook a scheduled, announced inspection on 4 November 2014. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector and GP specialist advisor. Additional inspection team members were a practice manager specialist advisor and a CQC pharmacy inspector.

The overall rating for the practice is GOOD

Our key findings were as follows:

  • Patients were able to get an appointment when they needed it.
  • Staff were caring and treated patients with kindness and respect.
  • Staff explained and involved patients in their treatment decisions.
  • The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
  • The practice met nationally recognised quality standards for improving patient care and maintaining quality.
  • The practice had met the requirements of the Gold Standards Framework for the care and support of patients at end of life and their families. Patients were supported to complete advance care planning documentation to record their end of life treatment decisions.
  • Patients were treated by suitably qualified staff.
  • GPs and nurses followed national guidance in the care and treatment provided.
  • The practice worked closely with the community to meet the specific needs of the patient population for example, co-ordinating patient appointments with the bus timetable and the delivery of patient medicines to outlying villages.

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

The provider should:

  • Undertake a risk assessment and develop and update standard operating procedures for the storage, dispensing and administration of medicines such as patient group directions and liquid nitrogen.
  • Ensure there are reasonable updates to the décor and repairs to the building based on a risk assessment whilst, planning permission for a new and updated building is agreed and the new building is finished.  
  • Improve systems to monitor the cleanliness of the building.
  • Ensure reasonable updates to the building and facilities are updated to improve access for patients with mobility needs whilst planning permission for a new and updated building is agreed and the new building finished.
  • Develop a schedule of regular clinical audit cycles to demonstrate organisational learning and change to patient care as a result.
  • Improve staff information about alternative agencies to contact when there are concerns about patients at risk of abuse.
  • Improve systems to audit minor surgery undertaken in the practice including the follow up of patient test results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice