Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Whiteparish Surgery on 12 January 2016. The practice breached regulations for safe, effective, responsive and well-led services and as a result, the overall rating for the practice was requires improvement. The full comprehensive report on the 12 January 2016 inspection can be found by selecting the ‘all reports’ link for Whiteparish Surgery on our website at www.cqc.org.uk.
Following the inspection the provider sent us an action plan that set out the actions they would take to meet the breached regulations. A focused desk-top inspection was then undertaken on 20 October 2016 to check the practice was meeting the regulations previously breached. For this reason we only rated the location for the key questions to which this inspection related.
We found the practice had made improvements since our inspection on 12 January 2016. The information we received enabled us to find the practice was meeting the regulations that it had previously breached for safe, effective and responsive services. However, due to an oversight on our part this inspection did not look to see if the practice was meeting the regulations for being well-led that it had previously breached. When we realised our error we arranged a second focused desk-top inspection to look at the outstanding issues which were:
- The practice did not have an adequate governance framework to support the delivery of the strategy and good quality care. We found a range of issues which would have been identified by the practice if their governance arrangements had been more robust. For example, the governance structure had not identified the lack of fire and safeguarding training, the lack of adequate prescription security and that fire alarm tests where not conducted.
- The programme of internal audit which was used to monitor quality and to make improvements had some gaps. For example, we did not see evidence of auditing of controlled medicines management or dispensing errors.
- Not all staff were aware of the legislation regarding the Duty of Candour.
This report covers the second focused desk-top inspection undertaken on 4 December 2017 to check the practice was meeting the regulation. We have changed the rating for this practice to reflect these changes. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. The practice is now rated good for the provision of well-led services.
Our key findings were as follows:
- All staff had completed approved on-line fire training and fire alarm tests were conducted.
- The practice had adequate prescription security.
- There was evidence of auditing of controlled medicines management or dispensing errors.
- All staff had completed approved online safeguarding training.
- All staff were aware of legislation concerning the Duty of Candour.
Overall the practice continues to be rated as Good.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice