Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Berinsfield Health Centre in Berinsfield , Oxfordshire on 20 July 2016 found breaches of regulations relating to the safe, effective and well-led delivery of services. The overall rating for the practice was requires improvement. Specifically, we found the practice to require improvement for the provision of safe, effective and well led services. The practice was rated good for providing caring and responsive services. The concerns identified as requiring improvement affected all patients and all population groups were also rated as requires improvement. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Berinsfield Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the three breaches in regulations that we identified in our previous inspection on 20 July 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 3 March 2017 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

• The practice had established and was now operating safe and effective systems to assess, manage and mitigate the risks identified relating to fire safety, gas safety checks, electrical installation, infection control, clinical waste and legionella.

• Blank prescription forms and pads were kept securely and tracked through the practice.

• The practice had revised recruitment processes and supporting documentation including Disclosure and Barring Service checks.

• National guidance had been embedded into the practice regarding patient specific directions (instructions to administer a medicine to a named patient).

• The practice was now effectively managing training arrangements, which were consistent and embedded across all staff groups. Personal and professional development was managed and recorded on a system which identified when staff had training and when it would need to be refreshed.

• There was an overarching governance framework which supported the delivery of the good quality care. Improvements had been made to deliver significant progress in improving services.

• The business continuity plan contained updated, comprehensive information to enable the plan to be used in an emergency.

• The practice had taken steps to improve rates of infant meningitis C vaccinations. The most recent data indicates figures for infant meningitis C vaccinations were 92%, which was a 9% increase on previously reported data and was in line with CCG figures of 95%.

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 Berinsfield Health Centre on 20 July. Overall the practice is rated as requires improvement.

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

• There was an effective system in place for reporting and recording significant events.
• Risks to staff and patients were not always fully assessed or well managed. For example risks relating to staff training, safety of the premises, medicines management, infection control, equipment, and recruitment checks had not been fully assessed or mitigated.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Most patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Policies did not always reflect appropriate guidance.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Introduce a system to make sure that all staff have undertaken adequate training appropriate to their role.
• Revise policies to reflect appropriate guidance and legislation and ensure the staff understand and follow these.
• Ensure appropriate assessments and actions have been taken and recorded for the maintenance and operation of the premises in relation to fire safety, gas safety checks, electrical installation checks, and legionella.
• Replace the kit for cleaning body fluids for one that is in date and introduce a system to monitor the expiry date.
• Store blank prescriptions securely and implement further measures to track their use at all stages.
• Ensure patient specific directions are appropriately used and completed.
• Make sure that clinical staff have access to appropriate medicines and equipment to treat emergencies when on home visits.
• Obtain and use the correct colour bins for disposal of sharps.
• Ensure that the infection control audit tool captures infection control concerns adequately and that actions to rectify concerns are carried out promptly.
• Ensure that appropriate recruitment checks are documented.

The areas where the provider should make improvement are:

• Carry out risk assessments to determine which staff should receive DBS checks.
• Make sure that the business continuity plan contains up to date and comprehensive information to enable it to be used in an emergency.
• Take steps to improve rates of infant meningitis C vaccinations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice