20 October 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Falmouth Road Group Practice on 20 October 2016 following previous inspections of the practice on 29 April 2015 and 5 January 2016. As a result of our initial inspection on 29 April 2015 the practice was placed into special measures. Inspections undertaken on 5 January 2016 and 20 October 2016 were intended to establish whether or not the practice had made sufficient improvement to enable them to be taken out of special measures. The practice remained in special measures after the inspection conducted on 5 January 2016. We found that the practice had not made sufficient improvement at our inspection on 20 October 2016 and is rated inadequate overall.
On the basis of our findings and the provider’s history of non-compliance we served a notice to cancel the provider’s registration under section 17 (1) (c) of The Health and Social Care Act 2008 on the basis that the provider was not carrying out the regulated activities in accordance with the relevant requirements of the 2014 Regulations.
Our key findings across all the areas we inspected were as follows:
- Risks to patients were not always assessed or well managed. For example the practice had not complied with the recommendations in their health and safety risk assessment and insufficient attention was paid to infection control.
- The practice nurse was not administering medicines in line with legislation and one of the partners did not have adequate medical indemnity cover in place.
- National patient survey scores were below national and local averages and some of these scores were lower than those at the time of previous inspections. However feedback obtained from patients during the inspection process indicated that most patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Patients said that access had generally improved. However it was evident from speaking to staff that there were not always a sufficient number of staff to meet patient demand. Urgent appointments were available the same day but patients could not book appointments online.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a clear leadership structure and most staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
- The provider was aware of and complied with the requirements of the duty of candour.
- Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
- There was an effective system in place for reporting and recording significant events however there was no evidence that patient safety alerts were being acted upon.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the clinical training to provide them with the skills, knowledge and experience to deliver effective care and treatment. However some essential training had not been completed by all staff including basic life support, infection control, child safeguarding and information governance.
Had we not served a notice proposing to cancel the provider’s registration, we would have set out the following list of ‘musts’ for their action:
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Put systems in place to ensure that valid Patient Group Directions are always in place for nursing staff administering medicines, that there are systems in place to monitor cervical screening samples and that clinical staff do not undertake consultations with patients without adequate professional indemnity insurance.
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Ensure that all mandatory training is completed in accordance with current guidance.
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Ensure that arrangements are in place to identified and mitigate against risks associated with infection control, health and safety and management of prescription pads and review arrangements around emergencies to ensure that all staff are trained, know how to operate emergency equipment and that all emergency medicines are secure and fit for purpose
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Ensure that there are systems in place to take and record action in response to patient safety alerts.
The areas where we would have said the provider should make improvement are:
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Ensure that all relevant staff are made aware of learning from significant events.
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Continue work on improving the management of patients in accordance with local and national targets.
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Give consideration to the style of complaint responses.
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Ensure that all staff receive adequate supervision, that all clinical employees are appraised annually and continue to work on improving staff morale and ensure that all staff are given adequate support.
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Put systems in place to improve the identification of and support offered to carers.
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Consider reviewing the level of staffing at the practice.
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Continue with action to engage with patients and address areas of concern or dissatisfaction raised in the national patient survey.
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Enable patients to book appointments online.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice