Archived: Princes Park Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Princes Park Surgery on 16 April 2015. Overall the practice is rated as inadequate. We found improvements were required for the safe, effective treatment of patients, how caring and responsive the practice was and how well the practice was led. We found the practice was good at caring for patients.

Our key findings were as follows:

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when things went wrong, reviews and investigations were not thorough enough and lessons learned were not communicated widely enough to support improvement.
• The provider did not deploy sufficient numbers of GPs to meet the demands of patients including in response to their urgent needs. The high usage of locum and agency GPs resulted in a lack of continuity of care, increasing the risk of patient incidents and complaints. There were insufficient numbers of patient appointments to meet the demands of the local population. Patients regularly had to wait outside the practice before it opened to ensure they got an appointment for later that day.
• Data showed that patients rated the practice higher than others for several aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice did not have systems in place to ensure locum GPs were monitored closely enough to ensure any changes to a patient’s care and treatments was actioned. There was no evidence that GPs completed clinical audits to assess and continually evaluate practice. Actions plans were not routinely developed when patient complaints or safety incidents occurred.

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

Importantly, the provider must:

• Review the system in place for reporting incidents. The written record of incidents and the information gathered was not sufficient in detail to adequately identify risks. The system for sharing the learning from incident reporting required improvement. Locum and agency GPs did not attend meetings where patient incidents and complaints were discussed. (Reg 12)
• Review the current arrangement for providing GP cover to the practice. The practice was unable to meet the demands of patients including in response to their urgent needs at all times. The high usage of locum and agency GPs led to a lack of consistency of care and increased the risk of patient incidents and complaints occurring. We found instances where locum GPs had not actioned changes required to patient’s medicines when they were reviewing patient discharge summaries. Systems should be set up to ensure that the work of locum GPs practice is monitored and feedback can be given. (Reg 12)
• Take timely and appropriate action to ensure accurate and up to date patient records are kept. There were significant delays to patient information being scanned onto their records, notably in the period before our inspection. This meant that patients attending the practice for a follow up appointment after their hospital visit were not seen by GPs with their full updated medical history. (Reg 17)
• Ensure that GPs complete clinical audits to assess and continually evaluate their practice.
• Ensure an action plan is developed to increase the practice performance for cervical smear uptake. (Reg 17)
• Review the appointment system to ensure there are sufficient numbers of patient appointments to meet the demands of the local population. (Reg 17)

In addition the provider should:

• Ensure doctors have emergency drugs available for use or have in place a risk assessment to support their decision not to have these available for use in a patient’s home.
• Include specific detail within the practice vision and strategy on how the particular cultural needs of patients living in this community will be met.
• Ensure that actions plans are developed when a patient complaint is made or a patient safety incident has occurred.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice