Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Leszek Piechowski and Partners on 7 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Dr Leszek Piechowski and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 February 2018 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 7 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The provider had resolved the concerns for safe and well-led services identified at our inspection on 7 June 2017 which applied to everyone using this practice, including the population groups. The population group ratings have been updated to reflect this. Overall the practice is now rated as good.

Our key findings were as follows:

• A process was in place to record and monitor the collection of controlled drugs prescriptions.
• There was a clinical supervision policy and a process to ensure all staff received an annual appraisal. Personal development and training plans were in place for all staff members. With the exception of the practice manager all staff had received an annual appraisal.
• Patient engagement was via a virtual Patient Participation Group (vPPG). Communication with the group had been strengthened since the last inspection. The practice now responded to feedback received indirectly, for example, via the NHS Choices website.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• Thermostatic mixer valves had been fitted to the hand wash facilities in the patient toilets. This ensured the water remained within a set temperature to avoid the risk of scalding.
• Hot water temperature checks were all within recommended levels to mitigate the risk of Legionella in the water system.
• A fire drill had been completed and future drills were scheduled. There was recorded evidence of the drill and actions had been taken following feedback from the staff members involved.
• All clinical staff had completed Deprivation of Liberty Safeguards (DoLS) training.
• The practice completed an audit of all deceased patients that included whether the patient had been on the palliative care register and the condition that had led to their death. However, this did not include whether the patient had died in their preferred place of death.
• Health promotion information and leaflets were available in the patient waiting areas. A prototype of the new practice website showed that it would include health information and links to external sites such as NHS Choices, counselling and well-being services.
• Ten appointments per week were made available to complete new patient and NHS health checks for people aged 40 to 74 years of age. Since the inspection in June 2017 338 NHS health checks had been completed. The practice had run three flu clinics that were held on Saturdays and were open access for all eligible patients to attend. These were advertised to patients on the practice website, in the patient waiting area and on repeat prescriptions. Any eligible patients that had not attended the flu clinics were contacted and offered an alternative date to receive their vaccination.
• Carers were supported in the practice by an identified carers lead. There was a carer’s noticeboard with useful information regarding support available in the patient waiting area. The practice informed us that information for carers was also made available at the designated flu clinics. The carers lead had introduced carer’s packs that could be taken away. They contained information on referrals to Northamptonshire Carers and of local drop in cafes and the contact details of the carers lead including telephone number and email address. The practice had identified 127 patients who were carers which equated to approximately 1.2% of the practice list.
• A new baby changing unit had been fitted. This had a wipe clean surface and straps to secure babies when in use.
• The practice policies and procedures were in hard copy format and available to all staff in the reception area of the practice. Pertinent information that may be required by staff such as contact numbers for local authority safeguarding leads and flow charts for what to do in case of a needle stick injury were available in the clinical rooms.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Complete the appraisal for the practice manager.
• Consider including whether a patient has died in their preferred place of death as part of the audit of deceased patients.

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 Leszek Piechowski and Partners on 7 June 2017. Overall the practice is rated as requires improvement.

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 had many clearly defined and embedded systems to minimise risks to patient safety. However, one of the processes relating to medicines management was insufficient.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The patients we spoke with or who left comments for us were very positive about the standard of care they received and about staff behaviours. They said staff were professional, helpful, respectful and friendly. They told us that their privacy and dignity was respected 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 raised directly with the practice.
• Almost all patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult. However, those patients said access to urgent and same day appointments was good.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure in place.
• The provider was aware of and complied with the requirements of the duty of candour.
• There were some weaknesses in the governance arrangements at the practice that could be strengthened to ensure the delivery of high quality care. The informal approach to nursing clinical supervision and nursing and non-clinical staff appraisal did not ensure that all staff had access to scheduled and documented supervision and appraisal of their skills, competencies, performance and development needs.
• Although some basic systems were in place, the practice’s engagement with patients in the delivery of the service was limited.

The areas where the provider must make improvements are:

• Ensure an appropriate system is in place for recording and monitoring the collection of controlled drugs prescriptions.
• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal.
• Ensure an appropriate system is in place to engage with and seek feedback from patients in the delivery of the service and respond to all patient comments.

The areas where the provider should make improvements are:

• Ensure that hand wash facilities meet the required specifications.
• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure that an annual fire drill is completed.
• Ensure that all clinical staff have sufficient knowledge of the Deprivation of Liberty Safeguards (DoLS).
• Ensure a process is in place to monitor and log trends in relation to deceased patients.
• Ensure that patients have access to a range of information about the services available, health promotion and access to advice and support groups through the practice website.
• Ensure that new patient health checks and NHS health checks for people aged 40 to 74 years are available and that improvements are made to the uptake of these services and the flu vaccination.
• Continue to identify and support carers in its patient population.
• Ensure an appropriate baby changing facility is provided.
• Ensure that policies and procedures are easily accessible to all 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 Dryland Surgery on 24 November 2015. Overall the practice is rated as good. However, we found the domain of safety to be requiring improvement.

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.
• Risks to patients were assessed and managed with the exception of recruitment procedures.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment although there were gaps in training for some staff.
• Patients satisfaction levels were generally above average and they said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP which was facilitated by their personal patient list system which ensured continuity of care. 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, although there was no formal appraisal process. The practice sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

To ensure DBS checks are carried out for all clinical staff and that risk assessments are carried out for to ascertain whether non clinical staff who undertake chaperone duties require a DBS check.

To ensure that thorough pre-employment checks are carried out on all staff.

To ensure the safe and secure storage of prescription pads.

To ensure that non clinical staff carrying out chaperone duties are appropriately trained.

The areas where the provider should make improvement are:

To establish a system for formal regular staff appraisal

To establish a system to ensure staff receive appropriate regular training and updates in areas such as infection control and fire.

To ensure regular fire drills are carried out.

To review the procedure for checking and recording emergency equipment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice