Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr Nicola Whitehouse on 22 August 2016 as part of our regulatory functions. The service was rated as requires improvement overall. The practice was rated as requires improvement for providing safe and well led services. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Nicola Whitehouse on our website at www.cqc.org.uk.

An announced focused inspection at Dr Nicola Whitehouse was carried out on 20 September 2017. We found improvements had been made and the overall rating for the service was good with requires improvement in providing safe services. You can read the follow up inspection report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Nicola Whitehouse on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 January 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 at our previous inspection on 20 September 2017.

The registered persons had not ensured there was proper and safe management of medicines. In particular:

• The results of all blood tests were not routinely obtained before giving patients’ a repeat prescription for high risk medicines.
• Guidance for staff on whether any uncollected prescriptions should be referred to the GP before they were destroyed was not in place.
• An effective system was not in place to ensure that medicine reviews were completed for all patients on repeat prescriptions.
• There was a lack of clarity on the process followed to review the medicines of patients with long term conditions at the time of their annual clinical review.

Overall the practice is now rated as Good.

Our key findings were as follows:

• Effective arrangements were in place to ensure the results of blood tests were obtained for all patients prescribed high risk medicines before giving patients’ a repeat prescription.
• There was guidance for staff on whether any uncollected prescriptions should be referred to the GP before they were destroyed.
• Effective systems were in place to ensure that medicine reviews were completed for all patients on repeat prescriptions.
• The process for reviewing the medicines of patients with long term conditions at the time of their annual clinical review had been updated to ensure this was carried out by the GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr Nicola Whitehouse on 22 August 2016. After the comprehensive inspection, the practice was rated as requires improvement for providing safe services.

We issued a requirement notice in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Safe care and treatment.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dr Nicola Whitehouse on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 September 2017 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 at our previous inspection on 22 August 2016. This report covers our findings in relation to those requirements.

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

• Although the practice had reviewed its systems and procedures for the management of medicines the improvements made were not sufficient to ensure the safe management of all medicines, prescribed for patients.
• A formal and active system for the safe management and monitoring of blank prescriptions had been implemented.

• Recruitment practices had improved to ensure that full employment checks were completed and relevant documents maintained and available for all staff employed.

• Arrangements for improving the uptake of childhood annual immunisations had been reviewed. Procedures had been implemented to ensure children who did not attend appointments were actively followed up and referred to the appropriate professionals.
• The practice had established links with relevant community professionals to assess and manage the care of patients with a learning disability.
• Procedures had been put in place to ensure the temperature of fridges containing medicines were regularly monitored.
• Systems and procedures to monitor children who fail to attend hospital appointments had been reviewed and appropriate procedures implemented.
• Measures to increase the uptake of cervical screening at the practice had been put in place.
• Regular fire drills were completed in line with Fire Safety Regulations in healthcare settings.

There were areas of practice where the provider must make improvements:

Ensure care and treatment is provided in a safe way to patients in particular:

• Ensure systems are put in place for the proper and safe management of medicines.

At this inspection we found that the practice had not fully addressed all the concerns raised and remains Requires Improvement for providing 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 Nicola Whitehouse on 22 August 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 report incidents and near misses.
• 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.
• Risks to patients were assessed with the exception of some areas related to the safe management of medicines, staff recruitment and fire prevention.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they meet people’s needs.
• 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 implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback received from patients.
• The practice had facilities which were well equipped to treat patients and meet their needs.

• The practice had a clear vision, which had quality and safety as its top priority.
• There was a clear leadership structure and staff felt supported by the management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure systems are put in place for the proper and safe management of medicines.
• Complete employment checks as required by legislation for all staff employed.

The areas where the provider should:

• Continue taking proactive measures to improve the uptake of childhood immunisations.
• Continue with plans to complete a comprehensive care plan for patients with a learning disability.
• Introduce a formal system for monitoring the use of blank prescriptions.
• Ensure that the systems introduced to monitor fridge temperatures are regularly monitored.
• Introduce a formal system for monitoring shared care agreements so that the practice is aware of the results of tests carried out before giving patients’ a repeat prescription.
• Introduce systems to monitor children who fail to attend hospital appointments.
• Continue taking proactive measures to improve the uptake of cervical screening.
• Fire drills must be completed in line with Fire Safety Regulations in healthcare settings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice