Archived: The Ivy Medical Group

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Ivy Medical Group on 18 July 2016. The practice was rated as requires improvement overall.

We then carried out an unannounced focused inspection of The Ivy Medical Group on 30 August 2016. This inspection was undertaken to follow up a Warning Notice we issued as a result of our inspection of 18 July 2016, as the practice had failed to comply with the regulations in respect of providing safe care and treatment for patients. This inspection cannot change the ratings. There will be a full re-inspection within six months of the publication date of the initial report.

Our finding across the areas we inspected was as follows:

• Detailed records were kept to evidence the receipt of and actions taken in respect of nationally available patient safety information including Medicines Health and Regulatory Authority (MHRA) alerts to ensure medicines were prescribed safely.

• The practice had reviewed the activities undertaken within the dispensary, consulted staff and produced updated standard operating procedures (SOPs are written instructions about how to safely dispense medicines) which reflected current practice.

• The arrangements for managing medicines in the practice kept patients safe and risks to patients were well managed. Specifically: effective systems were in place for shared care arrangements with secondary care to ensure adequate monitoring and follow up of patients on high risk medicines; repeat prescriptions dispensed at Lowdham medical centre were signed before the medicines were given to patients; and medicines were securely kept within the dispensary.

• Regular clinical meetings and staff bulletin updates were facilitated to promote learning from patient safety alerts and medicines related issues.

• The practice had purchased defibrillators for both sites (Lambley lane surgery, in Burton Joyce and Medical centre, in Lowdham) and staff had received relevant training for dealing with medical emergencies.

We found that the practice had complied with the Warning Notice.

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 The Ivy Medical Group on 18 July 2016. Overall the practice is rated as requires improvement.

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

• The practice was not receiving all of the available national patient safety alerts. Records reviewed also showed staff had not taken appropriate action in response to some of the alerts issued by external agencies.

• Lessons were shared to improve safety in the practice. However, the system in place for reporting, recording and analysing significant events needed to be strengthened to include near miss errors / incidents relating to the dispensary service.

• Some risks to patients were assessed and well managed with the exception of medicines management. The practice did not have effective arrangements in place to ensure the proper and safe management of medicines in respect of repeat prescription dispensing, handling of blank prescriptions, security of controlled drugs key and the dispensary from the parking area. Following our inspection the practice submitted additional evidence to demonstrate that improvement work had been initiated, and we will review this as part of our follow-up inspection.

• Although the practice was recruiting for additional clinical staff, current staffing levels did not always ensure the needs of patients were met in a timely way.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were supported with training and appraisals.

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

• Most patients said they found it easy to make an appointment with a named GP with urgent appointments available the same day.

• 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.

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

• The practice had applied for funding to make improvements to the design and layout of the Medical centre, Lowdham premises to ensure it was suitable for the provision of regulated activities and complied with legal requirements. A decision had yet to be made at the time of our inspection.

• 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 practice had some governance systems in place some of which were effective and supported the delivery of good quality care; others needed strengthening to ensure effective oversight and leadership.

• The practice participated in new models of care and local pilot schemes to improve patient outcomes in the local area.

The areas where the provider must make improvement are:

• Improve and embed robust processes and governance arrangements for managing medicines to ensure patient safety. This includes prescribing, recording, handling, storing, security and disposal.

• Maintain records to evidence the receipt of and actions taken in respect of nationally available patient safety information including Medicines Health and Regulatory Authority (MHRA) alerts to ensure prescribing remains safe.

• Ensure a functional automated external defibrillator is purchased as planned and in use following our inspection.

The areas where the provider should make improvement are:

• Review the systems in place for recording and acting on significant events and near misses related to the dispensary service, to try and identify and minimise reoccurring themes/issues so that patients receive safe care and treatment.

• Review the systems in place for shared cared arrangements with secondary care to ensure adequate monitoring and follow up of patients on high risk medicines.

• Review the practice staffing levels to ensure patients’ needs are met.

• Take steps to improve the uptake rates for NHS health checks for patients aged 40 to 74 years.

• Continue to review, monitor and act upon patient experience data (including the national GP patient survey results) to drive service improvement.

• Ensure there is leadership capacity to deliver all improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice