Archived: Rawnsley Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rawnsley Surgery on 27 April 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be inadequate for providing safe services and for people whose circumstances may make them vulnerable, requiring improvement for effective and well-led services and good for caring and responsive services. The concerns that led to these ratings apply to everyone using the practice including the population groups of older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students) and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, some incidents that may affect patient safety were not investigated.
• The practice did not have effective processes in place to minimise the risks from infections including those that are healthcare associated.
• We saw poor record keeping. We were told that patients had been offered assessments or treatment, but the actions were not recorded.
• We saw that the care offered to some patients with a learning disability did not meet their needs.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Staff were not always supported to review their performance using appraisals. We saw records where a member of staff had identified personal training needs and felt under supported, little action had been taken to address the situation.

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

Importantly, the provider must:

• Ensure that the recording, investigation and dissemination of significant events is robust.
• Ensure that risks that may affect patient safety are acted upon to minimise the risk of harm to patients.
• Ensure that risks to patients and staff from infection are minimised by adopting best practice infection, prevention and control guidance. This includes completing, recording and acting upon findings from regular infection control audits.
• Ensure that recruitment checks for staff reflect legislative guidance.
• Provide all staff at the practice with appraisals and the regular opportunity to explore individual training needs relevant to their role.
• Ensure that assessment and care that is offered to patients is recorded and reflects recognised guidance.

In addition the provider should:

• Improve security for the issue and tracking of blank prescription forms to reflect nationally accepted guidelines as detailed in NHS Protect.
• Review the emergency medicines held at the practice, to ensure that they are age appropriate for patients and cover the range of conditions that may be encountered in general practice. .
• Provide all staff with training in the Mental Capacity Act 2005.
• Review the process for recalling patients who require annual health checks to ensure all patients are included and that any refusal is followed up and documented.
• Use a team approach to ensure that the feedback collected from patients is recorded, discussed and used to plan and modify services.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice