Letter from the Chief Inspector of General Practice
Rishton and Great Harwood Surgery was inspected in September 2015. This inspection resulted in an overall rating of Requires Improvement, with an inadequate rating for the Safe domain. A Warning Notice was served against the provider on 26 October 2015. The provider was failing to meet the required standards relating to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe Care and Treatment. In June 2016 we carried out a focussed inspection of the Rishton site to check the provider had taken the required action in relation to the Warning Notice, where we found not all the required action had been taken in relation to risk management and recruitment of staff.
We carried out an announced comprehensive inspection on 7 September 2016 in order to fully re-inspect and assess what progress had been made.
During this inspection we found that insufficient improvements had been made.
Overall the practice is now rated as inadequate.
Our key findings across all the areas we inspected were as follows:
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Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate systems were not in place to monitor patients being prescribed with high risk medication.
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We found that appropriate action was not being taken to safeguard vulnerable children.
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The practice lacked a clear system for reporting incidents, near misses and concerns and there was limited evidence of learning and communication with staff.
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Staff did not have access to appropriate training. The practice had not implemented a system of appraisals in order to assess training needs.
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There was limited awareness of the need to protect confidential information within the practice.
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The practice lacked leadership and had limited formal governance arrangements.
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We received mixed feedback from patients about the manner in which clinical care was delivered by the GP
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Clinical audits demonstrated quality improvement.
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Patients were positive about their ability to access appointments at the practice.
The areas where the provider must make improvements are:
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Introduce more comprehensive processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
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The provider must ensure safe and effective management of medicines to include timely medication reviews and documentation of associated blood results, a system for recording prescriptions and improved security for storage of blank prescriptions.
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Ensure that staff checking vaccine storage fridges are adequately trained and procedures in line with regulations for the safe management of vaccines.
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The provider must ensure that appropriate and current patient information is shared on request with external agencies in particular in relation to safeguarding concerns.
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The provider must ensure there is a system of formal and documented communication between GP and staff.
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Ensure all patient identifiable information is stored securely and disposed of appropriately.
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Put systems in place to ensure all staff have access to appropriate training and support.
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Ensure that an appropriate risk assessment for lone working staff is completed in regards to whether a DBS check needs to be undertaken.
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Ensure a thorough system of risk management is implemented. Risk assessments that indicate mitigating actions are required must be followed through. Gaps in the assessment of risk within the practice, such as a legionella risk assessment, must be addressed.
The areas where the provider should make improvement are:
- All policies should be included on the newly devised policy inventory in order to be sure that all practice policy documents are reviewed appropriately when needed.
- References requested as part of the recruitment process need to be clearly identified as to who has provided them and when.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice