Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Lepton & Kirkheaton Surgeries on 21 January 2016. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
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The clinicians at the practice were skilled, compassionate and the two partners had joined the practice following a long period of upheaval and a high turnover of GPs. The practice, however, suffered from wide ranging systemic and management deficits.
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Patients were at an increased risk of harm because systems and processes were not in place to keep them safe. For example, there was limited learning from significant events, and actions arising from these events were not consistently implemented.
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There were inadequate safeguards for the monitoring of temperature sensitive vaccines.
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Some of the practice policies and procedures were out of date or undated and some contained obsolete information.
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Patient safety alerts were not appropriately managed. More than six months elapsed before the staff member with co-responsibility for monitoring and sharing alerts was added to the distribution list.
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A member of the nursing staff did not consistently follow the practice policy of referring all out of range blood results to GPs during disease reviews and had not received any recent clinical updates to support this decision making.
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There was no clinical supervision of nursing staff. Learning from complaints was not consistently undertaken and the practice had insufficiently addressed long-standing shortcomings in the attitude of a minority of reception staff.
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Patient outcomes were hard to identify as the practice had not undertaken any effective clinical audits or quality improvement.
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Patients were mostly positive about their interactions with staff and said they were treated with compassion and dignity. We found, however that patient survey results rated the practice lower than other practices in the area or nationally.
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The practice had no clear strategic plan.
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There was insufficient leadership capacity and limited formal governance arrangements.
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The practice had an active, supportive patient reference group who were engaged in supporting the new partnership.
The provider was aware of and complied with the requirements of the Duty of Candour.
The areas where the provider must make improvements are:
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Introduce effective processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and complaints.
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Take action to address identified concerns with out of date policies.
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Put systems in place to ensure all clinicians are kept up to date with national guidance, safety alerts and guidelines.
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Plan and carry out quality improvement initiatives to ensure improvements have been achieved.
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Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
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Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.
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Clarify the practice management structure and ensure there is leadership capacity to deliver all improvements.
We have issued warning notices with respect to the following regulations of the Health and Social Care Act (2008):
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Regulation 12 – Safe care and treatment
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Regulation 17 – Good governance
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Regulation 18 – Staffing.
The practice is required to make improvements in order to comply with these regulations.
I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.
Special measures will give people who use the practice the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice