Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Claire-Louise Hatton on 2 August 2016. The overall rating for the practice was good; however, the provider was rated as requires improvement for providing safe services as the arrangements to ensure the proper and safe management of medicines within the practice were not adequate. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr Claire-Louise Hatton on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 September 2017. This was 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 2 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good. The rating for the safe domain is now good.

Our key findings were as follows:

• There was a system in place to ensure stocks of medicines were within their expiry date.

• Storage arrangements for controlled drugs (medicine that require extra checks and special storage because of their potential for misuse) had been improved.
• Security of the premises had been strengthened and steps taken to ensure only authorised individuals could access medicines.

• The storage and security of blank prescription forms had been improved.
• Processes were in place to ensure medicines were stored within the correct temperature range and staff were aware of the importance of maintaining this.

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 Claire-Louise Hatton on 2 August 2016. Overall the practice is rated as good.

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

• The practice demonstrated an open and transparent approach to safety. There were systems in place to enable staff to report and record significant events. Learning from significant events was shared with relevant staff and stakeholders.
• Risks to patients were assessed and managed. A wide range of risk assessments were in place and were regularly reviewed and monitored.
• Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training had been provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
• Clinical audits were undertaken and showed improvements in the quality of care provided to patients.
• Feedback from patients was that they were treated with kindness, dignity and respect and were involved in decisions about their care.
• 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 proactively sought feedback from patients and staff through surveys.
• Patients said they could access appointments when they needed them with appointments available to book up to five weeks in advances and urgent appointments available on the day.
• There was a clear leadership structure which all staff were aware of. Staff told us they felt supported by the senior staff within the practice.
• There was a clear vision and mission which was shared with patients on the website and throughout the practice.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The provider had an agreement in place with CityCare to enable the practice to provide more flexible care for their patients. As part of the agreement the lead GP worked for one day per week at the Urgent Care Centre in Nottingham supporting and mentoring clinical staff to obtain their prescribing qualifications. In return the practice was supported by three advanced nurses (who were employed by CityCare) who worked at the practice three days per week. This led to an increase in clinical capacity within the practice. This had also contributed to a reduction in the emergency admissions to hospital and a reduction in the rate of patients not attending for appointments.

The areas where the provider must make improvements are:

Implement effective arrangements to ensure the proper and safe management of medicines within the practice including:

• Arrangements to identify and dispose of expired medicines
• The safe storage of controlled drugs in line with legislation
• General security of the dispensary including secure windows and limiting the personnel who could access the dispensary

The areas where the provider should make improvement are:

• Ensure there are systems in place manage the security of blank prescriptions in line with guidance
• Ensure the storage of medicines in the dispensary below 25 degree centigrade

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously inspected Jubilee Surgery in Lowdham on 20 June 2013 and 01 July 2013.

Following that inspection we had concerns relating to the provider taking steps to provide care in an environment that was suitably designed and adequately maintained. We had found the provider had effective systems in place to reduce the risk and spread of infection. The provider had also undertaken some assessments to identify and assess risk in relation to the premises; however more could have been done to ensure that people received care and treatment in surroundings that were safe.

We therefore returned to check that these issues had been addressed

On this occasion we did not speak with any patients but concentrated on speaking with the practice manager, carrying out a tour of the building and looking at the necessary records.

We found that improvements had been made to the environment where possible. Where it had not been possible to make the required improvements we found that appropriate risk assessments were in place to manage and reduce the risk to patients and ensure they were protected from unsuitable premises.

Patients told us they were treated with care and respect and we saw positive exchanges between patients and staff. One person said, “They’re really nice doctors, we’ve been very fortunate.” Most patients we spoke with told us and there could be problems getting an appointment although once they had got through to the surgery the service was, “Faultless.” They said their views about their care and treatment were listened to and that it met their needs.

We saw systems were in place for the safe management and dispensing of medication.

Although there were challenges, there were effective systems in place to reduce the risk and spread of infection. The provider had undertaken some assessments to identify and assess risk in relation to the premises however more could be done to ensure that people received care and treatment in surroundings that were safe.