Letter from the Chief Inspector of General Practice
This practice is rated as requires improvement overall. (The previous inspection was on 5 November 2014 and the practice was rated as Good.)
The key questions are rated as:
Are services safe? – Requires Improvement
Are services effective? – Good
Are services caring? – Requires Improvement
Are services responsive? – Requires Improvement
Are services well-led? - Requires Improvement
As part of our inspection process, we also look at the quality of care for specific population groups. The practice was rated as requires improvement for providing safe, caring, responsive and well led care. The issues identified as requiring improvement overall affected all patients.
The population groups are rated as:
Older People – Requires Improvement
People with long-term conditions – Requires Improvement
Families, children and young people – Requires Improvement
Working age people (including those retired and students – Requires Improvement
People whose circumstances may make them vulnerable – Requires Improvement
People experiencing poor mental health (including people with dementia) - Requires Improvement
We carried out an announced comprehensive inspection at Primrose Surgery on 9 November 2017 as part of our inspection programme.
At this inspection the key findings were as follows:
- We saw Patient Group Directions (PGDs) had been adopted by the practice to allow the nurse to administer medicines in line with legislation but we found that these had not been signed by the authorising body. (PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.)
- Significant events were not always discussed, analysed or reviewed in a timely manner at team meetings. We were not assured that when a patient was involved in a significant event, they received an apology and an explanation of what steps had been taken to prevent the same thing happening again.
- Practice meetings were held infrequently at approximately six monthly intervals, as were clinical meetings. We were told that the practice did not hold partners’ meetings or meet with members of the multi-disciplinary team, such as health visitors, midwifes, and safeguarding colleagues or meet to review those patients with palliative care needs.
- The practice made reasonable adjustments when patients found it hard to access services. For example, the practice had purchased a mobile phone to enable them to communicate effectively by text message with patients who were hard of hearing.
- The provider was unable to demonstrate that staff training, which would ensure that the team were suitably skilled and qualified to carry out their duties, was up to date or completed. We were not assured that regular appraisals were taking place or that they were effective. The staff induction process was poor.
- To support National self-care week the practice had invited a carers’ association, a cancer support charity and a local children’s centre into the practice to meet and inform patients of additional support services.
- The practice did not keep a record of the immunisation status of the staff team; in line with the guidance ‘Immunisation against infectious disease’ (‘The Green Book’ updated 2014.)
- Patient comment cards we received on the day were positive. However, responses to the National GP patient satisfaction survey 2017 were on average, 10% under the national average. Comments from patients we spoke with on the day were mixed.
- The majority of patients we spoke with reported they struggled to contact the practice by telephone to make appointments when they needed them. The practice showed us clear plans to update the system.
- The practice had a good knowledge of the needs of the local population and care was tailored to respond to this.
- Systems that were in place to manage risk were not always effective. For example, the practice had failed to ensure that window blinds in some clinical areas were compliant with the appropriate EU regulation (Directive 2001/95/EC) and posed a choking hazard.
- The practice had a number of policies and procedures to govern activity. However, a small number of these were not dated or were awaiting sign off from the GPs. On the day of inspection the management team had difficulty locating some policies.
The areas where the provider must make improvements as they are in breach of regulations are:
- The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- The provider must ensure that care and treatment is provided in a safe way for service users.
The areas where the provider should make improvements are:
- The provider should review the management of, and response to, complaints in line with best practice.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice