Archived: Whitby Group Practice Surgery - Green Also known as Dr England and Partners

This practice is rated as Good overall. (Previous rating February 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Whitby Group Practice Surgery – Green on 13 November 2018 as part of our inspection programme. We followed up on the areas that required improvement at the previous inspection (February 2018) and found these had improved.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient feedback identified that sometimes it was difficult to get through by telephone. The practice was monitoring this and acting to improve access by reviewing the telephone system.
• There were systems in place to mitigate safety risks including health and safety, infection control and dealing with safeguarding.
• 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 reviewed and considered patient views through surveys and a patient participation group (PPG).
• Staff worked well together as a team and all felt supported to carry out their roles.
• There was a focus on learning and improvement at all levels of the organisation.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Review the practice's storage of historic paper medical records to ensure they are stored safely.
• Review the security of printer prescription pads in the practice to ensure they are safe at all times.
• Review the system for reviewing incidents and significant events to include identification and recording of themes and trends.
• Review the system for implementation of National Institute for Health and Care Excellence guidelines.
• Review the system of appraisal to include salaried GPs.
• Review meetings structures to ensure all meetings are documented and notes of the meetings are disseminated.
• Implement an audit programme/plan that is based on national, local and practice priorities.

This practice is rated as Requires Improvement overall. (Previous inspection 19 November 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We rated the population groups as Requires Improvement overall because the issues identified as inadequate and relating to patient safety, effectiveness and providing a well-led service affected all patients.

At this inspection we found:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. However, the system for the management of safety incidents was not robust and needed improvement.

• Staff were able to identify and report safeguarding vulnerable adults and children concerns. However, the training of some staff was not up to date.

• The systems to manage high risk medication needed improvement to ensure sufficient safety measures were in place.

• Improvements were needed to the systems to manage infection prevention and control.

• Recruitment records did not contain all the necessary information to demonstrate the suitability of staff.
• A system was not in place to ensure the required safety checks of the premises took place when they were due.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff told us they felt supported and they had access to training and development opportunities appropriate to their clinical and non-clinical roles. However, improvements were needed to ensure all staff had completed the generic training they needed to ensure safe working practices.

• We saw staff treated patients with kindness and respect.

• Access to the service met patient’s needs. Access was monitored to ensure improvements where made if necessary.

• A system was in place to respond to and investigate patient complaints.

• The systems to promote good governance and management were not sufficiently robust.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out their duties.

• Ensure care and treatment is provided in a safe way to patients.

• Ensure that any complaint received is investigated.

The areas where the provider should make improvements are:

• The cleaning of clinical areas should be documented by all clinicians. Checks undertaken of the standards of cleanliness provided by the cleaners should be documented.

• The vaccine fridges should be hardwired or the plugs should be labelled to prevent them being turned off accidentally.

• Provide guidance to reception staff on how to identify symptoms that might be reported by patients with sepsis and how to respond.

• A risk assessment of the storage of paper patient records should take place.

• A log of MHRA alerts should be maintained so that the action taken and the alert can be referred to.

• The system to ensure alerts are placed on the parents of children where safeguarding concerns have been identified and on the records of vulnerable adults should be reviewed to ensure this alert is placed on all relevant patients’ records.

• The two week rule referral system should be improved by monitoring whether patients have been provided with an appointment.

• Develop a policy and procedure to increase staff awareness of the Accessible Information Standard.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice