Archived: Priory Avenue Surgery

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Priory Avenue Surgery on 27 November 2014. The practice was rated inadequate in the safe, effective and well led domains. The practice was rated requires improvement in the caring and responsive domains.

Our overall rating for the practice was inadequate.

On the basis of the ratings given to this practice at this inspection I am placing the provider into special measures.

Our key findings were as follows:

Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw staff treated patients with kindness and respect, and maintained confidentiality.

Some patients reported considerable difficulty in accessing a named GP and they experienced a poor continuity of care. However, all patients told us urgent appointments were usually available the same day.

Patients were at risk of harm because systems and processes were not in place in a way to keep them safe. The practice was going through a significant staffing crisis and there had been severe staff disruption in recent months. The practice was working closely with the NHS England area team to ensure they took immediate corrective action, which would enable them to fulfil their basic functions safely. The North and West Reading Clinical Commissioning Group were also monitoring the concerns and issues within the practice.

We saw no evidence that audit was driving improvement in performance to improve patient outcomes. We found, the recent staff shortages had an adverse impact on patient records. This posed a significant risk to patient safety as their patient records were not up to date with recent test results and discharge information from hospital. Therefore, patients may not have received appropriate follow up treatment or care.

There was no formalised induction programme for new administration and reception staff. However, training had taken place and staff felt supported by their immediate team and manager.

The practice did not have a clear vision and strategy. Staff we spoke with were not clear about their responsibilities in relation to the vision or strategy. There was no clear leadership structure and staff did not feel supported by the directors.

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

Importantly, the provider must :

• Document all recruitment and employment information required by the regulations in all staff members’ personnel files.
• Ensure all staff identified as requiring a criminal records check through the Disclosure and Barring Service (DBS) have one undertaken as soon as possible.
• Carry out risk assessments and document these to inform which members of staff required a DBS check and which staff did not.
• Take immediate corrective action to address current staffing issues to ensure safe minimum levels are reached.
• Implement a system to ensure all staff members receive regular supervision and appraisal.
• Provide clinical leadership and management to all practice staff.
• Develop a clinical audit process and implement findings from audits.
• Develop and maintain a system to identify risks and improve quality in relation to patient safety.
• Implement a process to disseminate learning from significant events, clinical audits, complaints and referral, to practice staff members.
• Take immediate action to ensure all patients’ records are updated with appropriate information and documents in relation to the care and treatment they have received.
• Undertake and record all relevant risk assessments.
• Undertake regular infection control audits that are documented and introduce a cleaning schedule for practice equipment.

Action the provider SHOULD take to improve:

In addition the provider should:

• Introduce a legionella risk assessment and related management schedule.
• Organise an induction programme for all new starters.

On the basis of this inspection and the ratings given to this practice the provider has been placed into special measures. This will be for a period of six months when we will inspect the provider again.

Special measures is designed to ensure a timely and coordinated response to practices found to be providing inadequate care.

We are currently piloting our approach to special measures, working closely with NHS England. The proposals we are piloting are that GP practices rated as inadequate for one or more of the five key questions or six population groups will be inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, they have failed to make sufficient improvement, and are still rated as inadequate for a key question or population group, we will place them into special measures. In a small number of cases, a GP practice will have such significant problems that people who use services are at risk or there may be sufficiently little confidence in the practice’s capacity to improve on its own. In these instances the practice will be placed straight into special measures.

Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid having its registration cancelled.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice