We carried out an announced comprehensive inspection at Attleborough Surgeries on 4 April 2018. The overall rating for the practice was good, with a requires improvement rating for providing safe services. We issued a requirement notice against regulation 12 of the Health and Social Care Act Regulations 2014, as the practice did not have effective systems for managing the risk of legionella bacteria contamination in the water supply, systems for managing the security of blank prescription stationary were not effective and some staff had not received up to date training for basic life support.

We also identified areas the practice could improve including the security of the dispensary, the systems for managing near misses, and the systems used to monitor and record staff training.

The full comprehensive report on the April 2018 inspection can be found by selecting the ‘all reports’ link for Attleborough Surgeries on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 4 April 2018.

This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is now rated as good, with a good rating for providing safe services.

At this inspection we found:

• The systems and processes were reviewed and improved to effectively manage the risk of legionella bacteria contamination in water systems.
• All staff were up to date with mandatory training including basic life support and the practice had introduced a colour coded system to record and monitor training and requirements.
• The practice reviewed and improved the systems for managing prescription stationery including the safe and secure storage and distribution which was managed through the dispensary.
• The practice had also reviewed and improved the security of the dispensary by limiting access to authorised personnel and installing new coded locks.

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.

Letter from the Chief Inspector of General Practice

Attleborough Surgeries have a practice population of approximately 17400 patients for Attleborough town and outlying villages. We carried out a comprehensive inspection at Attleborough Surgeries on 5 November 2014. Although Attleborough is the primary location patients could choose to be seen at Queens Square Surgery. Both these sites are registered with the Care Quality Commission (CQC) as one location. Both venues offer medicine dispensing services for patients who lived in excess of one mile from a pharmacy. We inspected Attleborough, we did not visit Queens Square Surgery.

We have rated each section of our findings for each key area. We found that the practice provided a safe, effective, caring, responsive and well led service for the population it served. The overall rating was good and this was because the practice staff were well organised which, led to an efficient service provided by motivated staff. Each senior member had dedicated roles. There was a written ‘practice plan’ dated 2014 to 2015 that described the services provided, the challenges and what actions senior staff planned to take to overcome them.

Our key findings were as follows:

• We found evidence that the practice staff worked together to make on-going improvements for the benefit of patients.
• Each day there was an assigned duty doctor to respond to any unexpected peaks in patient requests to be seen and to deal with other tasks on behalf of GPs who were on annual leave.
• The practice was able to demonstrate a good track record for safety. Effective systems were in place for reporting safety incidents. Untoward incidents were investigated and where possible improvements made to prevent similar occurrences.
• We found that patients were treated with respect and their privacy was maintained. Patients informed us they were satisfied with the care they received.

We saw an area of outstanding practice:

• As well as a Patient Participation Group (PPG) there was a patient reference group (PRG) of approximately 500 who were communicated with via email. This was set up to capture opinions from younger patients and patients who may work or be at home with children.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients told us they were happy with the service they received, were given sufficient time and were involved in decisions about their care and treatment. People with long term chronic conditions and those with complex palliative care needs were monitored appropriately to ensure their health and welfare needs were being met. This was confirmed by talking with staff and checking patient records.

Most staff had completed training in safeguarding children and vulnerable adults and were knowledgeable about the process. Safeguarding records we reviewed showed the practice worked with other professionals to help safeguard their needs. At the time of our visit, there was limited information available for patients to enable them to identify and raise safeguarding concerns.

We visited the dispensary at the practice and found that staff followed procedures to ensure that people received their prescribed medicines in a safe way.

Staff that we spoke with felt happy and supported by the practice team. Training opportunities were available and closely monitored. Staff received appropriate professional development and the nursing team had systems in place to support and supervise practice.

Patient and staff records that we checked were in good order.

This practice is rated as Good overall. (Previous inspection November 2014 – Good overall.)

The key questions are rated as:

Are services safe? – Requires improvement

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 Attleborough Surgeries on 4 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had good systems in place for the management of safety alerts and high risk medicines.
• Not all safety systems were operating effectively as there was insufficient oversight; for example, those relating to legionella and fire safety risk management and training.
• The practice did not monitor the use blank prescription stationary; however, they implemented a system the day of the inspection.
• Staff were trained in safeguarding, however oversight by the management team needed to be improved as they did not have evidence that all staff had received all necessary training. Not all staff were trained in fire safety or basic life support.
• The access for the dispensaries was not limited to authorised staff only. Learning from near misses was shared within the dispensaries.
• The practice had achieved high outcomes for the Quality and Outcomes Framework.
• The practice was generally in line with local and national outcomes on the GP patient survey.
• Patients commented positively on the care received by the practice.
• The practice had responded positively to the demands of local care homes and they supported them by implementing a care home team. Clinicians also carried out daily visits to a local boarding school to provide care.
• The practice responded to complaints in a timely and open manner.
• Staff reported there was high staff morale and low turnover of staff.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Review and improve the security of the dispensary.
• Review and improve the system for learning from and sharing near misses.
• Update the training matrix to provide complete oversight of staff training.

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