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Inspection carried out on 1 June 2017

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 Queens Walk Practice on 16 February 2016. The overall rating for the practice was good. However, within the key question safe some areas were identified as ‘requires improvement’, as the practice was not meeting the legislation for Safe care and treatment; Good governance; Staffing & Fit and proper persons employed.

The practice was issued requirement notices under Regulation 12, Safe care and treatment; Regulation 17 Good governance; Regulation 18 Staffing; and Regulation 19 Fit and proper persons employed. The full comprehensive inspection on 16 February 2016 can be found by selecting the ‘all reports’ link for the Queens Walk Practice on our website at www.cqc.org.uk.

This inspection was a focused desk based review carried out on l June  2017 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection on 16 February 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall, the practice is rated as good.

Our key findings were as follows:

  • The practice had implemented and was following a system to ensure all MHRA and medicines alerts were acted on.

  • All staff acting as a chaperones had the appropriate Disclosure and Barring Service check (DBS check) completed.

  • Locum staff at the practice had all the necessary employment checks.

  • A cleaning schedule was in place and was being monitored.

  • Staff had received appropriate infection control training and they were infection control audits in place.

  • Health care assistants were working in accordance to Patient Specific Directions to ensure they delivered care safely.

  • A risk assessment had been completed for the safe keeping of a large liquid nitrogen container used for surgical procedures to ensure it was stored safely.

In addition improvements had been made in the following areas we had recommended :

  • Improvements had been made to the recording of patients care plans.

  • The practice was ensuring that palliative care meetings were held.

  • The recording of team meetings was consistent to ensure staff had access to them if they had been absent on the day of the meeting.

  • The practice had developed and was following a formalised system of identifying carers.

We reviewed this information and made an assessment of this against the regulations.

The practice supplied an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation. Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment; Regulation 17 HSCA (RA) Regulations 2014 Good governance; Regulation 18 HSCA (RA) Regulations 2014 Staffing; and Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 16 February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queens Walk Practice on 16 February 2016. Overall the practice is rated as good.

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Most risks to patients were assessed and well managed. However the practice did not make use of Patient Specific Directives to ensure staff delivered care safely. The practice had also not carried out Disclosure and Barring Service check (DBS check) on reception staff acting as chaperones.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • 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.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

  • Ensure that health care assistants only work to Patient Specific Directives to deliver care safely.

  • Ensure systems are implemented for the safe management of prescription pads.

  • Ensure that medicines alerts are consistently followed up.

  • Take action to address identified concerns with infection prevention and control practice

  • Ensure regular fire drills are undertaken and that the practice undertakes a risk assessment for the safe keeping of the nitrogen tank in the surgical room.

  • Ensure staff receive appropriate infection control training.

  • Ensure recruitment arrangements include all necessary employment checks for all staff.

  • Ensure they undertake a risk assessment to carry out DBS checks on staff undertaking chaperoning duties.

In addition the provider should:

  • Ensure improvements are made to the recording of patients care plans.

  • Ensure that regular palliative care meetings are held.

  • Ensure they develop a consistent system that allows staff to access the staff meeting minutes if they had been absent on the day of the meeting.

  • Ensure the process of identifying carers is formalised.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice