Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Howells & partners (at that time known as Dr West & partners) on 18 May 2016. At that time, the practice was rated overall as good. However, we identified a breach in regulation relating to the way in which medicines were managed which resulted in a rating of requires improvement for provision of safe services. Specifically we found that learning from dispensary errors was communicated inconsistently, medicines were dispensed to patients before GPs had signed and authorised prescriptions and some medicines held for use in an emergency were out of date.

The practice sent us an action plan setting out the changes they were making to address the breach in regulation.

We carried out a focused inspection on 21 December 2016 to ensure these changes had been implemented and that the service was meeting regulation they had previously breached. The ratings for the practice have been updated to reflect our findings. We found the practice had made improvements in safe provision of services since our last inspection on 18 May 2016 and they were now meeting the requirements of the regulation in breach.

Our key findings in the area we inspected were as follows:

• The practice had introduced an effective system for reporting and learning from dispensing errors and “near misses”. This followed an improvement process designed by the Royal Pharmaceutical Society.

• Repeat prescriptions were being signed by GPs before medicines were dispensed to patients from both the practice dispensaries.

• The practice had an effective system for monitoring the medicines held for use in an emergency.

We have updated the ratings for this practice to reflect these changes. The practice is now rated good for the provision of safe services.

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 Howells & partners (at that time known as Dr West & partners) on 18 May 2016. At that time, the practice was rated overall as good. However, we identified a breach in regulation relating to the way in which medicines were managed which resulted in a rating of requires improvement for provision of safe services. Specifically we found that learning from dispensary errors was communicated inconsistently, medicines were dispensed to patients before GPs had signed and authorised prescriptions and some medicines held for use in an emergency were out of date.

The practice sent us an action plan setting out the changes they were making to address the breach in regulation.

We carried out a focused inspection on 21 December 2016 to ensure these changes had been implemented and that the service was meeting regulation they had previously breached. The ratings for the practice have been updated to reflect our findings. We found the practice had made improvements in safe provision of services since our last inspection on 18 May 2016 and they were now meeting the requirements of the regulation in breach.

Our key findings in the area we inspected were as follows:

• The practice had introduced an effective system for reporting and learning from dispensing errors and “near misses”. This followed an improvement process designed by the Royal Pharmaceutical Society.

• Repeat prescriptions were being signed by GPs before medicines were dispensed to patients from both the practice dispensaries.

• The practice had an effective system for monitoring the medicines held for use in an emergency.

We have updated the ratings for this practice to reflect these changes. The practice is now rated good for the provision of safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we visited Dr West and partners at Kintbury Surgery in January 2014 we found some systems relating to reducing the risk of cross infection were not operated effectively. We also found procedures to manage medicines were not always effectively operated. For example, a fridge holding vaccines was not lockable and was in a room that was not secured when not in use. We asked the provider to take action to address the issues we found and reported. The practice sent us a plan setting out the action they would take. We carried out this visit to check that action had been taken.

During this visit we spoke with the practice manager and two members of staff. It was not necessary to speak with patients. We found the practice had made significant improvements to address the issues identified at our previous visit.

We reviewed the processes and procedures in place to manage medicines. We found these were operated effectively. The risks associated with holding, prescribing and administering medicines had been reduced.

There were effective systems in place to reduce the risk of cross infection. Cleanliness and hygiene in the practice was appropriately managed and monitored and staff had received appropriate training in control of infection.

We found that care and treatment was planned and delivered in a way that was intended to ensure patient safety and welfare. One patient said "Kintbury surgery is very good and the staff are very caring and professional."

Patients were not always protected from the risk of infection because guidance had not been followed and effective systems had not been implemented. However, we found that patients were mostly cared for in a clean and hygienic environment.

The practice did not always have appropriate arrangements in place to manage medicines. We found that medications were not always stored correctly and robust expiry date checks had not been undertaken.

Staff received an appropriate check prior to commencing employment. We found that the practice had a documented recruitment and selection process and references were always taken.

We found that the practice had an effective system in place to identify, assess and manage risks to the health, safety and welfare. The practice sent regular surveys to patients to seek their feedback.