Letter from the Chief Inspector of General Practice

We carried out an announced focussed follow up inspection on 24 January 2017 to follow up on concerns we found at Abbey Medical Practice in May 2016. The inspection in January 2017 was to ensure that improvement had been made following our inspection in May 2016 when breaches of regulations had been identified. The inspection in May 2016 found breaches of regulation and rated the practice as requires improvement in safe services.

At the inspection on 24 January 2017 we found that overall the practice had implemented changes and that the service was meeting the requirements of the regulations. The ratings for the practice have been updated to reflect our findings following the improvements made since our last inspection in May 2016; the practice is now rated as good in providing safe services.

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

• Processes for reporting, recording, acting on and monitoring significant events, incidents and near misses including non-clinical were effective and implemented for all staff to follow.
• Emergency equipment and medicines were monitored and expiry dates were checked.
• A system for the flagging up of alerts for safeguarding vulnerable adults and children had been implemented and meetings were regular to ensure that outstanding safeguarding concerns had been followed up effectively.

• There was a robust system in place to ensure that patients were safeguarded from abuse and improper treatment, including documented discussions with the health visitors regarding children at risk.

• The practice had an effective system for monitoring high risk drugs with fail safes built in.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Abbey Medical Practice on 31 May 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However we found that the incident process that the practice had in place had not been adhered to.

• Risks to patients were not fully assessed and well managed.

• The practice was clean and tidy and an infection control audit had been completed.

• Data showed patient outcomes were in line with or above national averages.

• Audits had been carried out that were driving improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect.
• The practice had a number of policies and procedures to govern activity, which had been reviewed.
• Safety alerts were received and forwarded to staff in the practice to action as necessary.
• Portable appliance testing had been carried out and equipment had been calibrated and checked.
• Patients were able to get an appointment on the day and were happy with the appointment system and availability.

• Staff said they felt respected, valued and supported.

• All staff that were chaperoning had completed the chaperone training however some staff felt that refresher training would be appropriate.

• Emergency equipment and medicines were available however some of these were found to have expired.

• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Policies were in place and training had been undertaken however flagging up of alerts for safeguarding vulnerable adults and children and carers was not always correct or in place.

• There was no robust system in place for the monitoring of high risk drugs, such as methotrexate and lithium. Records did not show an alert that these patients needed monitoring and we saw that patients had not been monitored as required.

The areas where the provider must make improvements are:

• Ensure processes for reporting, recording, acting on and monitoring significant events, incidents and near misses including non-clinical are robust and implemented for all staff to follow.
• Ensure emergency equipment and medicines are monitored and expiry dates are checked.
• Review the current system for the flagging up of alerts for safeguarding vulnerable adults and children and carers and ensure that outstanding safeguarding concerns have been followed up effectively.
• Implement a robust system for monitoring high risk drugs.

In addition the provider should:

• Have a robust system in place to ensure that patients are safeguarded from abuse and improper treatment, including documented discussions with the health visitors regarding children at risk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with six people who received their primary medical care from the practice, one doctor and a nurse as well as administrative staff.

People who enquired about registering at the practice received leaflets which included information on staff, opening times and how their information would be stored and accessed.

The triage system ensured that people who needed to see a doctor urgently were able to do so on the day they contacted the practice. However, some of the people we spoke with told us they struggled to make an appointment in advance. One person said, “There is a problem getting in, you ring up and have to wait three weeks.”

People told us they were happy with the service they received at Abbey Medical Practice. One person said, “Of all the practice I have been registered with, this is the best.”

Records showed the provider identified and investigated both administrative and clinical incidents. Incidents were discussed and learning shared with the staff to reduce the risk of re-occurrence. For example, we saw as part of the triage system the reception staff now had a list of symptoms they must notify the doctor about so those triage calls can be prioritised.