Letter from the Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection at The Friary Surgery on 23 June 2016. Overall the rating for the practice was inadequate (safe and well-led inadequate, effective, caring and responsive as requires improvement) and was placed in special measures for a period of six months.
In particular, on 23 June 2016, we found the following areas of concern:
- There was an ineffective system in place for reporting and recording significant events. There was limited evidence to show that significant events and complaints were reviewed and thoroughly investigated to prevent further occurrences and secure improvements.
- When things went wrong, lessons learned were not communicated widely enough to support improvement. There was no evidence of any improvement action plans.
- Patients were at risk of harm because the systems and processes in place were ineffective. We found concerns in relation to health and safety, management of safeguarding, recruitment of staff, medicines management, infection control, safe storage of patient records and the ability to respond to clinical and non-clinical emergencies.
- The outcomes of patients’ care and treatment were not always monitored regularly.
- Clinical audits were not routinely carried out to improve care, treatment and people’s outcomes.
- The practice could not demonstrate how they ensured oversight of role-specific training and updating for relevant staff. Staff received some training but we identified staff that had not completed training in a range of areas that included safeguarding adults, fire safety awareness, basic life support, infection control and information governance.
- Whilst complaints were responded to lessons learned and action taken was not sufficiently detailed to assure lessons had been learnt. Complaints were not monitored over time to enable the practice to look for trends and areas of risk that may be addressed.
- The practice did not have an overarching governance framework which supported the delivery of good quality care. No formal meetings between staff took place. We were told any issues were discussed at daily coffee breaks. None of these meetings were recorded.
As a result of our findings at this inspection we took enforcement action against the provider and issued them with a warning notice for improvement.
Following the inspection on 23 June 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations and the warning notices that we issued.
We carried out a further comprehensive inspection at The Friary Surgery on 7 February 2017 to check whether the practice had made the required improvements. We found that all improvements had been made.
Our key findings across all the areas we inspected were as follows:
- There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
- Risks to patients were assessed and well managed.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
- On all but a small number of comments cards received, patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- 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.
- Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
- The practice was equipped to treat patients and meet their needs. Some areas of the practice required maintenance and redecoration.
- The provider was aware of and complied with the requirements of the duty of candour.
- The practice had significantly improved their governance framework. For example a structure of meetings, audits and completion of training had been put in place which provided an overarching governance framework which supported the delivery of the strategy and good quality care.
- The partners and new practice manager supported by staff demonstrated they had taken on board all the issues we identified at the previous inspection and had committed the practice to deliver improvement.
- The practice demonstrated a commitment to ensuring that the significant changes and improvement the practice had made would be monitored and embedded into future practice to ensure the improvement made was sustained.
The areas where the provider should make improvement are:
- Consider the arrangements for maintaining/redecorating the practice to ensure infection control risks are minimised particularly in treatment rooms.
- Formalise the arrangements for managing test results.
- Review the arrangements in respect of the practices implementation of the Accessible Information Standard.
- Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if appropriate.
- Ensure the improvement made is monitored and embedded into practice to ensure sustainability over time.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice