Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of 271a Southend Road on 16 October 2017. Overall the practice is rated as requires improvement.

Our key findings across all areas we inspected were as follows:

• Staff were able to recognise and reported significant incidents. We saw that actions, learning and follow up was documented.

• The practice had some clearly defined and embedded systems, processes and practices in place to minimise risks to patient safety. However there were actions from risk assessments and audits that had not been completed.

• The process for monitoring high risk medicines was not effective. We viewed a sample of records from searches of patients that were prescribed a high risk medicine and saw that reviews and monitoring was not in place for these patients.

• Blank prescription forms and pads were securely stored. The practice were recording the serial numbers but had not been tracking the prescriptions through the practice. This was changed the day of the inspection and the practice forwarded a copy of their new process and record sheet to document this.

• The practice had an overarching governance framework to support the delivery of the strategy and good quality care.Procedures and policies had been reviewed and updated. However, there was an inconsistent system for identifying, capturing and managing issues and risks.

• The practice sought feedback from staff and patients and we saw examples where feedback had been acted on. However, the practice did not have a patient participation group.

• Medicine and patient safety alerts had been actioned.We saw that the practice had a folder of all safety alerts that had been received. The practice produced evidence of searches already conducted in response to the alerts received.

• The practice were utilising the community specialist nursing teams to manage some of the patients with long term conditions. In addition to this staff that were working in the practice were completing reviews, immunisations and health screening. They were telephoning patients that were hard to engage.

• The practice had implemented clinical audit and we saw evidence of quality improvement.

• The practice had locum packs and checklists in place for locum recruitment. All patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had a comprehensive business continuity plan for major incidents such as power failure or building damage. The plan included arrangements for cover from local practices in the area should there be the need.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients including the prescribing of high risk medicines.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example, completing actions identified from infection control audits and risk assessments and ensuring there are systems in place in order to provide patient care in relation to the monitoring of patient’s health conditions.

In addition the provider should:

• Implement the procedure to ensure prescriptions are tracked throughout the practice.

• Continue to work to establish a Patient Participation Group.

• Review PGDs and ensure all are signed by GP in line with legislation.

• Continue to seek and act on feedback from relevant persons and other persons on the services provided in the carrying on of the regulated activity, for the purposes of continually evaluating and improving such services. For example telephone access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating October 2017 – Requires improvement overall particularly safe, effective and well-led.)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at 271a Southend Road on 28 November 2018 as part of our inspection programme to follow up on concerns found at the previous inspection.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice had implemented an effective system to monitor patients being prescribed high risk medicines.
• The practice had completed actions required from the infection control audit. We found there was a proactive approach to risk assessments however one action had not been completed from the fire risk assessment. Since the inspection the practice had implemented a system to ensure alarm checks were documented.
• Staff understood their responsibilities to manage emergencies on the premises. Clinicians knew how to identify and manage patients with severe infections including sepsis. However, we found that non-clinical staff members were unable to recognise patients with suspected sepsis. The practice did not have the appropriate medicine or equipment to deal with sepsis or other potential medical emergencies.
• We generally found that care plans were completed appropriately however we found that in some cases mental health and dementia care plans were incomplete.
• QOF data published in 2017/18 found the practices clinical performance indicators for patients with long term conditions and mental health were below local and national averages. The practice was aware of their clinical performance and had implemented a process that had improved their performance indicators to a satisfactory level.
• We found there was an ineffective system to review patients with gestational diabetes in line with NICE guidance.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had acted on patient feedback they had received. They had changed the appointment system and patients reported greater satisfaction since the change.
• The practice had a strong focus on implementing technology to improve treatment and to support patients’ independence.
• There was a focus on continuous learning and improvement at all levels of the organisation. Staff were encouraged to share responsibilities and develop their roles.

The areas where the provider should make improvements are:

• Continue to develop systems to monitor clinical performance and patient outcomes for patients with long-term conditions and those suffering with poor mental health.
• Strengthen the system to review patients with gestational diabetes in line with NICE guidance.
• Improve systems and process to manage medical emergencies such as sepsis.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.