Archived: Park Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced, comprehensive inspection of ELM Alliance Limited on 11 July 2017 and 12 July 2017. We identified six breaches of regulations and issued warning notices for three of the breaches. This focused inspection carried out on 9 November 2017 was to check whether the provider had taken steps to comply with the legal requirements for these three breaches. The three breaches of regulation we inspected against were for:

• Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and Treatment.

• Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safeguarding Service Users from Abuse.

• Regulation 17: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance.

The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Park Surgery – ELM Alliance on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 9 November 2017 to confirm that the service 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 11 and 12 July 2017. This report covers our findings in relation to those requirements.

Our key findings were as follows:

Improvements had been made with respect to patient safety, effectiveness and leadership following our last inspection on 11 and 12 July 2017. For example:

• New processes had been put in place to report and manage significant events and safeguarding concerns.

• Patient safety and medicines alerts were being received, assessed and when necessary, actioned appropriately.

• Improvements had been made with regard to effective governance and management within the service. For example, training and recruitment records were centrally recorded and all staff received an induction to the service.

• Health and safety risk assessments were underway.

However, there were also areas of practice where the provider needed to make improvements:

The provider must:

• Ensure that entries of medicines are correctly and fully recorded in the controlled drugs’ register.

• Check stock balances of controlled drugs on a weekly basis, in accordance with the provider’s own policy, to ensure that amounts held reflect what has been entered into the controlled drugs’ register.

• Ensure that quantities of medicines supplied are clearly indicated in records and on prescriptions.

The provider should:

• Have a system in place to check expiry dates of items on the emergency trolley.

• Replace, re-stock and re-order items which are found to have passed their expiry date, when undertaking checks of the emergency trolley.

• Document any learning points from significant events or incidents on the recording matrix used by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection of ELM Alliance Limited Extended Hours and Out of Hours service (known as the STAR service) on 11 and 12 July 2017 as we had received some information of concern about the out of hours service being provided. Overall the service is rated as inadequate. We visited two locations that the service is delivered from; Park Surgery in Middlesbrough and Bentley Medical Practice at Redcar.

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

• There was no open and transparent approach to safety and no effective system in place for recording, reporting and learning from significant events.
• Risks to patients were not adequately assessed or acted upon.
• We found concerns about the management of medicines.
• There was a system in place that enabled staff access to patient records, and information was shared with the patients GP following contact with patients using the out of hours service
• The service managed patients’ care and treatment in a timely way with the exception of home visits which were below the national quality requirements.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Safeguarding procedures were not always followed.
• There was a lack of overarching governance.
• There was an ineffective system for handling complaints and complaints handling was not used to improve services within the organisation.
• The vehicle used for home visits was not well equipped and some emergency equipment was not readily available at the sites visited.
• There was a leadership structure but communication between staff and management was limited and some staff felt unsupported by managers.

The areas where the provider must make improvement are:

• Implement appropriate processes for assessing and checking that the candidate holds the required qualifications and has the competence, skills and experience required and is of good character.

• The provider must deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff to make sure that they can meet people’s care and treatment needs.

• Providers should use incidents and complaints to identify potential abuse and should take preventative actions, including escalation, where appropriate.

• The Provider must maintain a record of all complaints, outcomes and actions taken in response to complaints. Complainants must be kept informed of the status of their complaint and its investigation and be advised of any changes made as a result. The provider should monitor complaints over time, looking for trends and areas of risk that may be addressed.

• The provider must establish systems and processes and operate effectively to ensure they assess, monitor and mitigate the risks relating to health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity. Fire drills should be carried out and outcomes documented. Fire training for all staff must be kept up to date. There must be an appropriate documented fire risk assessment in place that is bespoke to the out of hours service provided from each location.

• The provider must ensure the safety of their premises and the equipment within it. Process and systems must be in place that assure compliance with statutory requirements, national guidance and safety alerts. There must be documented processes in place for monitoring clinical equipment, to ensure that it is fit for purpose and that disposable items are in date.

• Medicines must be available in the necessary quantities at all times.

• Incidents that affect the health, safety and welfare of people using services must be reported internally and to relevant external authorities. They must be reviewed and thoroughly investigated by competent staff, and monitored to make sure that action is taken to remedy the situation, prevent further occurences and make sure that improvements are made as a result.

• Systems and processes must support the confidentiality of people using the service and not contravene the Data Protection Act 1998. Smart cards (a unique user system for accessing electronic patient records) must only be used by the person whom the smart card has been issued to and the practice of sharing or using another person's card must cease.

The areas where the service should make improvements are:

• Clinical supervision should be facilitated for all clinicians and this should be recorded. One to one support should be made available to all staff.

• An effective induction programme which includes areas of mandatory training should be implemented.

• Infection control audits, specific to each location must be undertaken and these should include action plans and review dates.

• The provider should implement an effective process to make sure that all staff are kept up to date and informed of key issues taking place at the service.

• Have systems in place to ensure that National Quality Requirement (NQR) key performance indicators are met each month in respect of face to face consultations in patients’ homes.

• Implement an effective system to record staff training and be satisfied that this is accurate and up to date.

• Implement an effective system for the management of controlled drugs, in line with the provider’s Home Office licence.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take 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 a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice