Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 1 March 2016. A breach of legal requirements was found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Fit and proper persons employed

How the regulation was not being met:

Recruitment arrangements did not include all necessary employment checks for all staff.

Regulation 19(3)(a) schedule 3

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

Regulation 12 of the Health and Social Care Act 2008

(Regulated Activities) Regulations 2014: Safe care and treatment

How the regulation was not being met:

The registered person did not do all that was reasonably practicable in managing medicines safely; medicines, including controlled drugs, were not stored safely and securely or disposed of appropriately in accordance with the relevant legislation.

Appropriate systems and processes were not in place to assess, monitor, and improve the quality of services in relation to the dispensing of medicines.

Guidance for the security of blank prescriptions was not being followed.

Regulation 12(2)(g)

Care and treatment was not provided in a safe way for service users because some aspects of the management of medicines and recruitment checks were unsafe.

Specifically:

The arrangements for storing controlled drugs did not ensure that medicines, including controlled drugs, were stored safely and securely (including checking fridge temperatures daily), and disposed of appropriately in accordance with the relevant legislation.

The practice did not keep a ‘near-miss’ record (a record of dispensing errors that have been identified before medicines have left the dispensary) and there were no records of dispensing errors that had reached patients. This meant errors could not be analysed, and learning shared to prevent reoccurrence.

No procedure was in place to track prescription forms after they had been received into the practice, which would identify if any were missing.

Recruitment arrangements did not include all necessary employment checks for all staff.

We undertook this focused inspection on 6 December 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Browney House Surgery on our website at www.cqc.org.uk

Our key findings were as follows:

Care and treatment was provided in a safe way for service users through the proper and safe management of medicines for the purposes of the regulated activity.

Recruitment arrangements now included all necessary employment checks for staff.

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 Browney House Surgery on 1 March 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. Information about safety was recorded, monitored, appropriately reviewed and addressed. However, we found that some of the systems to keep patients safe had not been implemented effectively.

• The practice had a number of policies and procedures to govern activity, however the standard operating procedures in the dispensary did not cover all processes required.

• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and the practice nurse was undertaking further training in respiratory disease management.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment. There were urgent appointments available the same day for GPs and Nurses. Routine appointments were available to book the following day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Information about services and how to complain was available and easy to understand.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.

The areas where the provider must make improvement are:

The practice must:

Ensure that medicines, including controlled drugs, are stored safely and securely (including checking fridge temperatures daily), and disposed of appropriately in accordance with the relevant legislation.

Ensure recruitment arrangements include all necessary employment checks for all staff.

The areas where the provider should make improvement are:

The practice should:

Ensure appropriate systems and processes are in place to assess, monitor, and improve the quality of services in relation to the dispensing of medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with three patients who attended the surgery on the day of our inspection. They told us they were happy with the service. One patient said “This is one of the nicest doctors’ I’ve ever been to.” Another said “I can get an appointment when I need one; I don’t have any problems with that.”

We saw the practice had safeguarding policies in place for both children and vulnerable adults. There was an identified lead clinician with a clear role to oversee safeguarding within the practice.

We found the practice was generally clean. Some of the equipment within the surgery was unsuitable for infection control purposes.

We saw medications were stored in locked cabinets within a locked room. We found all medicines were in date. We also saw prescription pads were held securely with access restricted to named staff members.

We found staff received regular training and supervision. Staff told us they felt supported by their managers.