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Archived: The Flowers Health Centre Good

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Reports


Inspection carried out on 8 February 2017

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Flowers Health Centre on 23 March 2016. Although, the overall rating for the practice was good, we found the safe domain required improvements. The full comprehensive report on the 23 March 2016 inspection can be found by selecting the ‘all reports’ link for The Flowers Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 February 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 23 March 2016. This report covers our findings in relation to those requirements and any additional improvements made since our last inspection.

.Overall, the practice is now rated as good in the safe domain and good overall.

Our key findings were as follows:

  • At our previous inspection on 23 March 2016, we rated the practice as requires improvement for providing safe services, we found that staff had not had the necessary recruitment checks prior to staff commencing work. These arrangements had significantly improved when we undertook a follow up inspection on 8 February 2017. We reviewed three personnel files and found the practice had undertaken the appropriate recruitment checks prior to staff commencing work.

  • At our previous inspection on 23 March 2016, we found that the practice did not maintain a record of actions taken in response to National Patient Safety Alerts (NPSA). in regards to equipment and medication. At this inspection, we found the practice manager maintained a record of each NPSA and what actions the staff had taken.

  • At our previous inspection on 23 March 2016, we found staff could not locate the procedures to follow if a needle stick injury occurred and copies of the procedure were not located in areas where this injury may occur. At this inspection, we found staff had reviewed and could locate the policy and posters about the actions to take if an injury occurred were located in the treatment rooms.

  • At our previous inspection on 23 March 2016, we found that staff had not always cleaned equipment used for patient care in line with the manufacturer’s instructions and had not maintained records to monitor the cleaning. At this inspection, we found staff had information about how to clean the equipment following the manufacturer’s guidance and staff had kept a record of when it was cleaned.

  • At our previous inspection on 23 March 2016, we found the practice had a defibrillator available on the premises and oxygen with adult and children’s masks, but we noted that the equipment was only checked to ensure it was in working order once a month. At this inspection, we found staff checked the equipment daily.

  • At our previous inspection on 23 March 2016, patients told us that they had difficulty in contacting the practice by telephone. At this inspection, we found the practice had identified issues with the telephone lines, which had been addressed. Prior to this inspection, they had carried out a questionnaire that asked patients ‘do you have a problem getting through on the phone today’. The practice had 17 responses, 12 were completely satisfied, and five stated they got through on the second call.

  • At our previous inspection on 23 March 2016, we found that the practice manager could not demonstrate how they ensured that the practice nurses had completed the necessary role specific training and updates. At this inspection, we found the practice manager kept an overview of all role specific training for staff and had ensured the nurses had completed their role specific training. However, we found that the record showed that staff had not completed adult safeguarding training. Following the inspection the practice manager provided us with information to demonstrate staff had completed training

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 23 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Flowers Health Centre on 23 March 2016. Overall the practice is rated as good.

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.
  • Risks to patients were assessed and managed although some shortfalls in relation to recruitment and equipment were identified.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. However training was not adequately monitored to ensure staff received updates when due.
  • 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.
  • Patients could get same day appointments but they told us they experienced difficulties accessing the practice by telephone and making an appointment with a GP of their choice.
  • 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 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.

We saw two areas of outstanding practice:

  • The practice had initiated a project to improve the care for patients with advance care plans. They had identified a number of incidents where agreed care plans had not been adhered to for patients in care home settings and 999 ambulances had been called resulting in patient admissions to hospital. This had been discussed at peer review meetings which identified this as a problem locally. Data collection and an initial review of the systems in place were being undertaken with peers and other agencies such as the out of hour’s team and emergency department. The aim of the project was to reduce unnecessary emergency department attendances and hospital admissions for patients and ensure patients wishes were respected.

  • The practice had reviewed referral processes to secondary care as they had identified the practice had high referral rates. Actions taken included discussing all referrals with a second GP to ensure the referral was appropriate. This process had helped them to identify where there may be an alternative to secondary care referrals. For example, referring to an in house or federation/locality based service. The lead GP told us this had resulted in a reduction in referrals made by the practice. The practice had also identified this was a good mechanism for learning and had continued with this process.

The areas where the provider must make improvement are:

  • Ensure recruitment arrangements include the necessary employment checks for all staff prior to employment.

The areas where the provider should make improvement are:

  • Maintain a record of the actions taken in response to national patient safety alerts.

  • Ensure procedures to be followed in the event of a needle stick injury are accessible to all staff at risk.

  • Implement systems to ensure staff receive necessary training updates in relation to their role, taking into account relevant guidance such as The Health Protection Agency National Minimum Standards for Immunisation Training 2005.

  • Implement systems to ensure equipment used for patient care is cleaned in line with manufacturer’s instructions and records are maintained to evidence this.
  • Implement systems to ensure emergency equipment is checked and in working order in line with the Resuscitation Council (UK) guidance and maintain records of the checks completed.

  • Improve telephone access to the practice for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice