Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boothstown Medical Centre on 2 December 2016. The overall rating for the practice was good however there were improvements required in the key question safe. The full comprehensive report on the 2 December 2016 inspection can be found by selecting the ‘all reports’ link for Boothstown Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 23 October 2017 to confirm 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. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The Practice is now rated as good for being safe and overall the practice remains rated as good..

Our key findings at this inspection were as follows:

• We reviewed a range of documents which demonstrated they were now meeting the requirements of Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe Care and Treatment.
• The practice had ensured that all staff had completed the level of safeguarding training relevant to their role.
• The practice now had a system in place to monitor and act upon patient safety alerts.
• The practice had a policy in place to assist staff in taking action should the vaccine fridge fall outside of the safe temperature range.
• The practice had now carried out a risk assessment to determine which emergency drugs should be kept on the premises.
• The practice ensured that sharps boxes were stored in a secure location of all clinical rooms.
• All medical stock within the practice was monitored and rotated to ensure any out of date stock was disposed of.

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 Dr R Anderson and Dr M Ahmed, also known as Boothstown Medical Centre on 02 December 2016. Overall the practice is rated as good.

The practice had been previously inspected on 14 October 2014. Following that inspection the practice was rated overall requires improvement with the following domain ratings:

• Safe – Requires improvement

• Effective – Good

• Caring – Requires improvement

• Responsive – Requires improvement

• Well-led – Requires improvement

The following requirement notices were issued as the practice was not meeting the legislation in place at that time for the following:

• Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Cleanliness and infection control

• Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines

• Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service providers

Following this re-inspection on 02 December 2016 our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice did not have a system in place for managing patient safety alerts.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Not all clinical staff had completed the level of safeguarding training appropriate to their role.
• There was a clear leadership structure and staff felt supported by management. However, one member of the clinical team told us they sometimes felt overworked and unsupported. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure clinical staff have completed the level of safeguarding training appropriate to their role.

• Ensure the practice has a robust system in place for monitoring and acting upon patient safety alerts, and that these are regularly discussed in clinical meetings.

• Ensure action is taken when the vaccine’s storage fridge falls outside of the correct temperature range.

The areas where the provider should make improvement are:

• The practice should make sure that sharp disposal boxes are in a secured location.

• The practice should make sure that the medical record storage room is kept locked when not in use.

• The practice should consider disposing of out of date equipment.

• The practice should consider performing a risk assessment of what emergency drugs are to be stocked.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of the practice of Dr R Anderson and Dr M Ahmed. The practice is registered with the Care Quality Commission to provide primary care services. We undertook a planned, comprehensive inspection on 14 October 2014 and spoke with two GPs, the nurse practitioner, two nurses and other staff including the practice manager.

The practice required some improvements and was rated as requiring improvement overall.

Our key findings were:

• Staff understood their responsibilities to raise concerns, and reported incidents and near misses. When things went wrong reviews and investigations were carried out. Out of date medication and equipment was found at the practice and there was no system in place to ensure that all of the medical equipment used by GPs was within its expiry date. The cleaner, who was not directly employed by the practice, had access to the medicines and blank prescriptions as they entered the premises when other staff had gone home. There was no system in place to check the amount of medicines or blank prescriptions at the practice.

• Data showed patient outcomes were at or above average for the locality. National Institute for Health and Care Excellence (NICE) guidance was used routinely. Staff had mostly received training appropriate to their roles. Staff appraisals and personal development plans were up to date.

• The majority of patients said they were treated with compassion, dignity and respect. However the practice had a below average score on the national GP patient survey for receptionists being helpful. We observed breaches of confidentiality at the reception desk. The privacy of patients having intimate examinations was not always respected and chaperone arrangements were not consistent.

• Although the patient participation group (PPG) had carried out a patient survey this did not focus on the needs of their local population, or ask questions about how the service could be improved. Patients told us it was difficult to access an on–the-day appointment with some telling us they had to wait up to a month to see a GP. The appointment system was not monitored so the practice was not aware of the difficulties faced by patients.

• The practice had a statement of purpose but this was a short hand written document. Staff were not aware of its existence and we saw no evidence of the practice having a set of values. The PPG carried out surveys but we saw no evidence their views were representative of the patient population.

There were areas of practice where the provider needed to make improvements.

Importantly, the provider must:

• The provider must ensure there is an effective system to ensure an appropriate standard of cleanliness and hygiene were maintained throughout the practice was not in place.  The provider is failing to meet Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.

• The provider must ensure there is an effective system to record what medicines are held at the practice and manage the disposal of medicines returned by patients. Blanks prescriptions must be  kept in a secure manner. The provider is failing to meet Regulation 13 of the Health & Social Care Act 2008 (Regulated Activities) Regulations.

• The provider must take action to put in place an effective system to regularly assess and monitor the quality of the service. Although patients were consulted about some aspects of the service questions were not asked that enabled the provider to have an informed view of their opinion. Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

In addition there were areas where the provider should make improvements:

• Although complaints were investigated and related learning was document there was no evidence that improvements took place following learning.
• Patients told us it was difficult to access GP appointments with some patients stating they had to wait up to a month for an appointment. Access to appointments was also difficult for patients who were working. The availability of appointments was not monitored by the practice.
• The arrangements for patients undergoing intimate examinations did not protect their privacy and dignity.
• Confidential information was disclosed at the reception desk and could be heard by people in the waiting area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice