The Care Quality Commission
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Archived: Two Shires Medical Practice

Overall: Good read more about inspection ratings

Old School Surgery, 2a Station Street, Kibworth, Leicester, Leicestershire, LE8 0LN (0116) 279 2422

Provided and run by:
Two Shires Medical Practice

All Inspections

20 April 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Two Shires Medical Practice was previously known as Dr Kilpatrick and Partners.

We had previously carried out an announced comprehensive inspection at this practice on 28 July 2016 and found breaches of regulation and rated the practice as ‘Requires improvement’ in the safe and well-led key question. The practice was rated as ‘Requires improvement’ overall. The full comprehensive report on the 28 July inspection can be found by selecting the ‘all reports’ link for Dr Kilpatrick and Partners on our website at www.cqc.org.uk.

Specifically we found that;

  • There was no effective system that enabled health care assistants to administer medicines and vaccines in line with the legal requirements.

  • The quality and safety of services were not being assessed, monitored and improved and not all the necessary polices and protocols were in place and followed when action was required.

This inspection was an announced focused inspection carried out on 20 April 2017 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 28 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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The practice is now rated as ‘Good’ in the safe and well-led key questions and ‘Good’ overall.

Our key findings were as follows:

  • There were clear policies and protocols in place to ensure that health care assistants only administered medicine and vaccines in line with the legal requirements.

  • The practice had reviewed its arrangements for the checking of emergency equipment and fridges used to store vaccines to ensure their efficacy.

In addition we found that:

  • Damaged seating had been replaced.

  • Emergency medicines and equipment at the Old School Surgery had been secured to prevent unauthorised access.

  • The practice had continued to actively seek to identify carers.

  • Relevant test results of patients on high risk drugs recommended by secondary care were documented.

  • There was an increased frequency of meetings for nursing and healthcare assistants.

  • The practice was working with the patient participation group to help increase the group’s involvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

28 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kilpatrick & Partners on 28 July 2016. Overall the practice is rated as requires improvement.

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

  • There was an effective system in place for reporting and recording significant events

  • Lessons learnt were recorded as a result of incidents and discussed at practice meetings, however we found evidence to show there was inconsistent learning and implementation of actions to improve safety in the practice.

  • Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons.

  • The practice was visibly clean, however we noted that the seating area in the waiting area at Old School Surgery required repairing.

  • Arrangements to manage medicines, including emergency medicines and vaccines were not always followed, this included checks on fridge temperatures that stored vaccines at Fleckney Surgery.

  • The practice did not have a system of legal authorisation for healthcare assistants to administer medicines to patients.

  • Relevant tests were not always recorded in relation to patients on high risk medicines.

  • Checks on emergency equipment at Fleckney Surgery were not always carried out.

  • Emergency medicines and equipment at Old School Surgery were not stored securely.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • We observed staff members were courteous and very helpful to patients and treated them with dignity and respect.

  • Feedback from residential homes included that the reception staff were helpful, courteous and polite.

  • The practice offered extended hours in the morning, Monday to Friday, as well as on a Saturday for working patients who could not attend during normal opening hours.

  • Patients told us that it was difficult to get through to the practice by phone and that there was a wait to see a doctor for a routine appointment.

  • Feedback from residential homes told us they could generally contact the practice by phone, however commented that at times it could be busy.

  • Lessons were learnt from complaints and discussed with staff.

  • There was a leadership structure in place and the partnership was evolving. Staff told us they felt supported by management.

  • The practice had a governance framework which supported the delivery of the strategy and quality care. However, we found some of the framework required strengthening to ensure policies and protocols were followed.

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

  • The practice encouraged and valued feedback from patients, the public and staff.

  • There was a focus on continuous learning and improvement at all levels.

The areas where the provider must make improvement are:

  • Ensure there is a system of legal authorisation for health care assistants to administer medicines and vaccinations are maintained and monitored in line with legal requirements

  • Ensure the quality and safety of the services provided are assessed, monitored and improved, including ensuring policies and protocols are in place and followed and actions are undertaken when needed.

The areas where the provider should make improvement are:

  • Ensure damaged seating areas are repaired or replaced.

  • Ensure emergency medicines and equipment are stored securely.

  • Document relevant tests in relation to patients on high risk medicines at all times.

  • Continue to identify and support carers.

  • Consider a process to ensure effective communication for all staff including the extended clinical team.

  • Continue to develop and ensure an active PPG.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice