Archived: Silver Springs Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Silver Springs Medical Practice on 15 December 2016. The overall rating for the practice was inadequate and it was placed in special measures for a period of six months. The practice was also issued with a Warning Notice and a further focused inspection was carried out on 12 April 2017 to ensure that the practice had complied with the legal requirements of the Warning Notice. The full comprehensive report on the 15 December 2016 and 12 April 2017 inspections can be found by selecting the ‘all reports’ link for Silver Springs Medical Practice on our website at www.cqc.org.uk.

After the inspection on 15 December 2016 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was an announced comprehensive inspection undertaken on 23 August 2017 following the period of special measures. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

• The practice now had systems for receiving and actioning patient safety alerts.

• Significant events were now being recorded, discussed, actioned and learned from to help improve patient safety.

• Medicines were managed safely including repeat prescriptions and high risk medicines.

• All staff who acted as chaperones received a DBS (Disclosure and Barring Service) check.

• All staff were now receiving an annual appraisal.

• The practice was carrying out audits to drive quality improvements in services.

• Although improved compared to the last inspection, patient satisfaction with phone access and some aspects of care was still lower than national and local averages.

• We could not find evidence that a Legionella risk assessment had been carried out by someone with the qualifications, competence and experience to do so.

• The practice had a range of policies and procedures, but they were not always specific to the practice.

• We did not see evidence of a data sharing confidentiality agreement between the practice and the supporting organisation.

• The practice were seeking and acting on feedback from patients.

  There were areas of practice where the provider needs to make improvements.

  Importantly, the provider must:

• Ensure systems and processes are established and operated effectively to assess and monitor the service. This includes polices being specific to the practice, the detailed recording of significant events and verbal complaints and where indicated include a confidentiality sharing agreement between relevant parties.

• Ensure systems and processes are in place to identify and assess risks. This includes ensuring the training matrix is up to date and that records of the interview process and copies of staff induction forms are retained in staff files.

In addition the provider should:

• Assess and manage the risks to the health and safety of patients and staff by completing outstanding plumbing works and have a legionella risk assessment carried out by someone with the qualifications, competence and experience to do so. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).

• Review ways of increasing the percentage of patients with dementia receiving face to face interviews.

• Consider ways of improving blood pressure control in patients with raised blood pressure and in particular those with diabetes.

• Gain further feedback from patients with a view to reviewing and improving patient satisfaction.

  I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Silver Springs Medical Practice on 15 December 2016.

The practice was rated as inadequate overall and was placed in special measures. Practices placed in special measures are inspected again within six months of publication of the last inspection report. If insufficient improvements have been made and 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.

Additionally, breaches of the legal requirements were found because the practice was not ensuring the safe care and treatment of its patients and staff and systems and processes had not been established and operated effectively. Therefore warning notices were served in relation to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe Care and Treatment and Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17 Good Governance.

Following the comprehensive inspection, we discussed with the practice what they would do to meet the legal requirements in relation to the breach and how they would comply with the legal requirements, as set out in the warning notices.

We undertook this announced focused inspection on the 12 April 2017, to check that the practice had followed their plan and to confirm that they now met the legal requirements in relation to the warning notices. This inspection does not alter the practice’s current ratings as it is still in special measures. A further comprehensive inspection will be taking place within six months of the original inspection at which the practices rating will be re-assessed.

During this inspection the practice provided records and information to demonstrate that the requirements of the warning notice had been met. However, a further requirement notice was served to make sure that the practice further enhanced its systems and processes in relation to medicines management. You can read the report from our last comprehensive and focussed inspections by using the link for Silver Springs Medical Practice on our website at www.cqc.org.uk.

The area where the provider must make improvements are:

• Ensure that safe and effective systems and processes are implemented to prevent the duplication of repeat prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Silver Springs Medical Practice on 15 December 2016. Overall the practice is rated as Inadequate.

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

• Patients were at risk of harm because systems and processes were not always in place to keep them safe. For example, disclosure and baring service checks or risk assessments were not undertaken to assess or mitigate the risk to patients; the practice was not registered to receive drug alerts and therefore had not taken action against 12 alerts within the last 12 months. Patients taking high risk medicines were not receiving regular reviews to ensure their medicines were still effective or safe to take.

• Staff were not always clear about reporting incidents, near misses and concerns. The recording of incidents was poor and there was limited evidence of learning and communication with staff.

• Patient outcomes were hard to identify as limited audits or quality improvement were undertaken and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

• Appointment systems and access to the practice by telephone were not working well and the practice had taken limited action to make improvements.

• The practice had a weak leadership structure, with insufficient leadership capacity and to support effective formal governance arrangements.

• The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients highlighted via feedback that they found it difficult to access the practice via the telephone at peak times.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure the practice seeks and acts on all feedback in order to make improvements to the services provided for patients.

• Implement effective systems which assess, monitor and mitigate risks to the health, safety and welfare of patients.

• Assess the risks to the health and safety of patients arising from ‘significant events’ and then mitigate any identified risks.

• Ensure the proper and safe management of medicines with regard to the handling of repeat prescriptions and high risk prescriptions.

• Have regard to CQC’s guidance for providers on meeting the regulations in so far is to relates to complying with relevant Patient Safety Alerts, recalls and rapid resonse reports issued from the Medicines and Healthcare products Regulation Agency (MHRA) and through the Central Alerting System (CAS)

• Ensure all staff receive appraisal to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvement are:

• Review the leadership arrangements to ensure improvement.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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 service 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 by adopting our proposal to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice