12 October 2017
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Circuit Lane Surgery on 24 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months and specific conditions were applied to the registration of the practice.
On 2 June 2017 we carried out a focused inspection at Circuit Lane Surgery to determine whether the practice was meeting the conditions applied following the January inspection. At that time we found some improvements and three of the six conditions applied were removed. However, the practice had not made sufficient improvements and remained in special measures. Both reports from the January 2017 and June 2017 inspections can be found by selecting the ‘all reports’ link for Circuit Lane Surgery on our website at www.cqc.org.uk.
This inspection was undertaken following the period of special measures and was an announced follow up comprehensive inspection on 12 October 2017. Overall the practice continues to be rated as inadequate.
Our key findings were as follows:
- There was a system in place for reporting and recording significant events.
- The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
- We reviewed four personnel files and found appropriate recruitment checks had been undertaken prior to employment.
- The practice had adequate arrangements in place to respond to emergencies and major incidents.
- The GPs and nursing staff had access to relevant and current evidence based guidance and standards. However, the care of patients diagnosed with asthma did not always follow these guidelines.
- The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). The most recent data from the QOF year April 2016 to March 2017 showed performance had fallen from the previous year. The practice was an outlier for meeting indicators of care for patients diagnosed with asthma and diabetes. Data supplied by the provider for the period April 2017 to October 2017 showed that overall the practice has made an improvement on the previous year.
- The practice had a clear and safe procedure for medicine reviews.
- Staff had the skills, knowledge and experience to deliver effective care and treatment. However, the clinical pharmacist and senior advanced nurse practitioner did not receive or access clinical supervision.
- The information needed to plan and deliver care and treatment was available to relevant staff in a timely and accessible way through the practice’s patient record system and their intranet system.
- Staff sought patients’ consent to care and treatment in line with legislation and guidance. Although further understanding of the Mental Capacity Act 2005 was needed.
- We observed members of staff were courteous and helpful to patients and treated them with dignity and respect.
- Results from the national GP patient survey were consistently below local and national averages.
- The practice had a system in place for handling complaints and concerns. There were notes of meetings where complaints were discussed and learning shared.
- The provider’s vision to deliver high quality care and promote good outcomes for patients but this was not always supported by effective leadership and governance processes.
- There were arrangements for identifying, recording and managing risks within the practice. However, some risks were not addressed in a timely way. For example, the risk associated with patients waiting for long periods of time on the phone to seek advice or book appointments.
- Practice specific policies were implemented and were available to all staff.
- The practice had used most of their resources since the inspection in January addressing the areas of high risk and the clinical and administrative backlog.
There were areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
- Ensure care and treatment is provided in a safe way to patients
In addition the provider should:
- Operate a system of providing clinical supervision that is received and accessed by all relevant staff.
This service was placed in special measures in January 2017. Insufficient improvements have been made such that there remains a rating of inadequate for provision of effective, caring, responsive and well-led services. Therefore we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice