Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr P Craven and Dr N J Cunningham on 12 January 2017. The overall rating for the practice was good with requires improvement for providing safe services. The full comprehensive report on the 12 January 2017 inspection can be found by selecting the ‘all reports’ link for Dr P Craven and Dr N J Cunningham on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 July 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 in our previous inspection on 12 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• Significant events were formally recorded, reviewed and learning shared with staff. However, a system to review significant events to identify patterns or trends was not in place.

• Infection control issues were assessed and actioned accordingly.

• Systems for reviewing patients prescribed a high risk medicine had been implemented.

• A suitable medicines refrigerator was in use in the dispensary.

• Patient Group Directions were signed and authorised.

We also saw the provider had implemented the best practice recommendations we previously made in relation to providing an effective and caring service:

• A salaried GP’s appraisal had been completed.

• A partition wall between two consultation rooms was in the process of being completed to ensure that private conversations were not overheard.

• Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

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

The provider should:

• Implement a system to review significant events to identify patterns or trends.

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 P Craven and Dr NJ Cunningham (Allen Street Clinic) on 12 January 2017. Overall the practice is rated as good.

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

• Risks to patients were assessed and managed.

• 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 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.
• Patients said they found some difficulty in making an appointment with a named GP.
• The practice was equipped to treat patients and meet their needs.
• There was a 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. (The Duty of Candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

The areas where the provider must make improvement are:

• Ensure Patient Group directions are signed and authorised.
• Ensure infection control issues are monitored and actioned accordingly.

The areas where the provider should make improvement are:

• Ensure the INR blood levels of all patients on repeat warfarin are closely monitored before prescriptions are issued.

• Make arrangements for the refrigerator in the dispensary to be replaced by a suitable medicines’ refrigerator.

• Formally record and review significant events and disseminate the learning from them

• Undertake GP appraisals.
• Maintain dignity and privacy of all patients.
• Consider a training update around Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
• Review the use of the partition between clinical rooms, where consultations can be overheard.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice