Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Debenham Group Practice on 18 August 2016. The practice was rated as good overall with a rating of requires improvement for providing safe services. As a result of the findings on the day of the inspection the practice was issued with a requirement notice for Regulation 12 (Safe care and treatment). You can read our findings from our last inspections by selecting the ‘all reports’ link for Debenham Group Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 May 2017 to confirm that the practice had carried out the improvements needed to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 18 August 2016. This report covers our findings in relation to those requirements.

The key findings from our inspection on 22 May 2017 were as follows:

• The systems and processes to ensure patients taking high risk medicines had been monitored appropriately had been improved.

• Two GP partners had taken a lead role in quality improvement and regular audits to monitor quality had been performed. We noted that this had led to more discussions amongst the clinical staff to further improve the electronic summaries of medical records.

• We found the practice had significantly improved the process to ensure that patients affected by national patient safety alerts were identified and their treatment reviewed in response to the alert. We reviewed the practice log which detailed the alert received and actions taken.

• Security arrangements had been implemented for blank prescription forms; pads were securely stored and there were systems to monitor their use.

• The practice had implemented a standard operating procedure for carrying out and recording stock checks of controlled drugs in line with national guidance and we saw that regularly stock checks of controlled drugs were recorded and where necessary actions taken.

• We also noted that, since our last inspection, the practice had made additional improvements. For example, a bar code scanner had been introduced in the dispensary to improve the dispensing process and dispensary staff described a process for ensuring second checks by another staff member or doctor when dispensing certain medicines, for example controlled drugs.

• A weekly news briefing was sent to all staff alerting them to updates, reminders, training, and news.

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 Debenham Surgery on 18 August 2016. Overall the practice is rated as Good.

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 used a range of assessments to manage the risks to patients; however these needed to be improved.

• Practice 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.

• The practice had increased the usual appointment time to 12.5 minutes, longer appointments were available for those that needed them. Patients said they did not always find it easy to make an appointment with a named GP; however, they were always able to make an appointment with any GP. Urgent appointments were available the same 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.

• The provider was aware of and complied with the requirements of the duty of candour.

• All staff had a good awareness of the needs of patients whose circumstances made them vulnerable. We saw numerous examples of the proactive and person centred approach for individual patients. The practice identified and provided additional support to patients and in working with other agencies. We saw how people had been supported to maintain their independence and to live at home and access community and voluntary services. This helped ensure their welfare.

However there were areas of practice where the provider must make improvements:

• Ensure that there are more robust processes in place to ensure patients prescribed high risk medicines have the necessary monitoring to support safe prescribing.
• Improve governance arrangements to ensure quality of medical record summaries and incoming patient letters.
• Implement an effective process to ensure that patients affected by national patient safety alerts are identified and their treatment is reviewed in response to the alert.

There were also areas of practice where the provider should make improvements:

• Maintain an audit trail of blank prescriptions in line with national guidance.
• Ensure that a standard operating procedure is in place for carrying out and recording stock checks of controlled drugs in line with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During this inspection we visited the main surgery in Debenham, but did not visit the two branch surgeries.

We spoke with 13 people who were waiting for their appointments during our inspection. They unanimously told us that they had very positive experiences of the service and were satisfied with the treatment provided and with the friendly attitude shown by all staff working at the practice.

People had received care and treatment after they had been assessed and examined.

Safeguarding policies and staff training need to be improved to assure children and vulnerable adults will be protected from abuse.

The premises were well maintained, comfortable and appeared clean. Overall, the premises were a safe and suitable environment for people and for staff to work in.