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Ashington House Surgery Requires improvement

Reports


Inspection carried out on 19 November to 19 November

During a routine inspection

We carried out an announced comprehensive inspection of Ashington House Surgery on 19 November 2019 as part of our inspection programme and in response to concerns identified at a previous inspection.

At the last inspection on 9 January 2019 we rated the practice as requires improvement for providing safe and well-led care because of issues regarding staff training, policy reviews, infection prevention and control, and the management of clinical referrals. At this inspection we found the practice had addressed these issues, but that there were new concerns in providing safe care and treatment.

We based our judgement of the quality of care at this service on a combination of:

  • What we found when we inspected
  • Information from our ongoing monitoring of data about services and
  • Information from the provider, patients, the public and other organisations.

The practice continues to be rated as requires improvement overall.

We rated the practice as requires improvement for providing safe, and well led services because of several issues with systems to manage patient safety, prescription items, and actions from infection prevention and control audits. We also found a lack of clarity from leaders around succession arrangements.

We rated the practice as good for providing effective, response and caring services because:

  • Patients received effective care and treatment that met their needs except for patients with long term conditions.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • Quality outcomes were in line with the Clinical Commissioning Group and England averages.
  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.

We rated the population group of patients with long term conditions as requires improvement. All other population groups have been rated as good.

We found areas where the provider must make improvements. The provider must:

  • Ensure that care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We found several areas where the provider should make improvements. The provider should:

  • Continue to develop a centralised system to monitor appointment delays or track when a patient has missed a referral.
  • Continue with measures to address and improve exception reporting for mental health indicators.
  • Continue to implement actions to increase uptake for the cervical screening programme.

(Please refer to the requirement notice section at the end of the report for more detail).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 9 January 2019

During a routine inspection

We carried out an announced comprehensive inspection at Ashington House Surgery on 9 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall, requires improvement for providing safe, effective and well led services and good for providing caring and responsive services.

We have rated it as good for all of the responsive population groups and requires improvement for the effective population groups. This means that the population groups are rated as requires improvement overall.

We found that:

  • Not all staff who acted as chaperones had been appropriately trained.
  • Not all policies and procedures were up to date or had been adequately reviewed to ensure that information contained was accurate and current.
  • Clinical waste was not always disposed of correctly.
  • Non-clinical staff had not received sepsis training and were unaware of sepsis or the signs to look for.
  • Referrals were not managed appropriately as there were no checks in place to ensure that appointments had been made.
  • Many PGDs were either out of date, not signed or not signed by all staff who were required to sign them.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • Feedback from patients was consistently positive and was higher than local and national averages.
  • Quality outcomes were in line with the Clinical Commissioning Group and England averages.
  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care, particularly for older people and people with long term conditions.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please refer to the requirement notice section at the end of the report for more detail).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 25 January 2017

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We undertook a focussed follow up inspection of Ashington House Surgery on 25 January 2017. This was to follow up our inspection on 14 September 2016 when we found that the practice was rated good overall but requires improvement for the provision of safe services. The practice required improvement in safe care due to risks to patients relating to the secure storage of blank prescriptions. We also found that the practice should: Ensure that all patients with long term conditions have the support and care they need; Ensure a record of actions and a review of outcomes from significant events and safety alerts; Ensure that nurses are administering medicines under a legal authority.

Following our focussed follow up inspection the practice overall rating remains as good. We have now rated the provision of safe care to patients as good.

The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Ashington House Surgery on our website at www.cqc.org.uk.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. There had been one review of the significant events to identify any areas for learning. There was a further meeting planned for March 2017 to review the previous year.
  • Risks to patients were assessed and well managed, the security of blank prescriptions had been addressed, blank prescriptions were stored securely. The practice was tracking the prescriptions into the premises but had not established a system to track the prescriptions through each clinical room.

  • The nurses were administering medicines under the correct legal authority.

  • The practice had established a system to record actions following any medicine or equipment safety alerts.

  • Patients with long term conditions were receiving the appropriate support and care.

In addition the provider should:

  • Establish a system to monitor the use of blank prescriptions through the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 14 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashington House Surgery on 14 September 2016. Overall the practice is rated as good.

The practice was previously inspected in October 2014 and previously rated good overall, with requires improvement in safe care due to risks to patients relating to the maintenance of the premises and the equipment.

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

  • During the inspection in September 2016 we did not find any concerns or risks to patients relating to the maintenance of the premises and the equipment.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However there was no annual review of actions to identify any areas for learning.
  • Risks to patients were assessed and well managed, with the exception of those relating to management and security of blank prescriptions.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. We saw evidence that audits were driving improvements to patient outcomes although these were limited.
  • 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.
  • 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 there are appropriate arrangements for the secure storage of presriptions and systems to monitor their use, including in treatment rooms.

In addition the provider should:

  • Ensure that all patients with long term conditions have the support and care they need.
  • Ensure a record of actions and a review of outcomes from significant events and safety alerts.
  • Ensure that nurses are administering medicines under a legal authority

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 23 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an inspection of this practice on 23 October 2014 as part of our plan of inspections. It was a comprehensive inspection and this practice was chosen because it had not been inspected using our new methodology.

Overall, we found this practice needs improvement. We found the practice worked well with other agencies in order to meet the health needs of patients. There was good analysis and resulting action when significant events occurred and complaints were treated seriously. Most patients were happy with the care and treatment they received and the majority of patients would recommend the practice to others.

Our key findings were as follows:

  • There were arrangements in place to respond to the protection of children and vulnerable adults and to respond to any significant events affecting patients well-being.

  • The practice worked well with other health care service to enable a multi-disciplinary approach in meeting the health care needs of patients receiving a service from the practice.

  • Patients told us they were treated with respect and kindness and staff maintained their confidentiality.

  • Most patients were able to have an appointment on the same day unless they wished to see a particular GP. Some patients said if they wanted to see a particular GP for continuity of care and treatment they had to wait. The practice took complaints seriously.

  • There was a clear management structure with approachable leadership. Staff were supported and had opportunities for developing their skills. The provider responded to feedback from patients.

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

Importantly, the provider must:

  • Ensure equipment and services are properly maintained.

  • Ensure there is a full employment history of each person appointed to work in the practice by obtaining two written references before staff commence employment.

  • Ensure the premises are safe and access is available in the event of fire.

In addition the provider should:

  • Make arrangements for the security of blank prescription forms when not in use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice