19 May 2015 and 3 July 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
This is the report from our announced comprehensive inspection of Crossways Practice on the 19 May and 3 July 2015.
We previously undertook a focused inspection at the practice in February 2015 in response to an issue of concern. We issued three Requirement Notices as a result of our findings and requested an action plan. A comprehensive inspection was then undertaken on 19 May 2015 when we could see that some improvements had been made. At the 19 May inspection the practice had not reached the final date for compliance against their action plan from the February inspection. We therefore carried out a further visit on 3 July 2016 to ensure the provider had met the Requirement Notices from February 2015. We are therefore reporting on both inspections within this one report.
Overall the practice is rated as good.
Our key findings were as follows:
- The provider had met the Requirement Notices and made improvements in quality assurance processes and supporting staff.
- Following a period of instability in staffing arrangements, the practice had recruited a permanent nurse and a GP who started work in June 2015. The practice was in the process of recruiting a practice manager.
- There were systems in place to mitigate safety risks including analysing significant events and safeguarding. Systems were in place to ensure medication including vaccines were appropriately stored and in date. The practice used a pharmacy advisor to ensure the practice was prescribing in line with current guidelines.
- A Local Medical Director had been recently appointed to oversee the clinical governance of the practice and was proactively encouraging the use of clinical audits to ensure patients received treatment in line with best practice standards.
- Patients had their needs assessed in line with current guidance and the practice had a holistic approach to patient care.
- Feedback from patients and observations throughout our inspection highlighted the staff were kind, caring and helpful.
- The practice was responsive and acted on patient written formal complaints.
However, there were also areas of practice where the provider needs to make improvements.
The provider should:
- Carry out a risk assessment to ascertain the need for a defibrillator for the practice.
- Consider staff feedback, and then communicate to staff what actions will be taken and when, to address concerns raised.
- Formulate a maintenance plan to improve the overall décor and fixtures and fittings within the practice identified in the external risk assessment carried out in March 2014.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice