Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on May 2015 and a focused inspection in January 2016. During both inspections we found the same breach of legal requirement and the provider was rated as requires improvement under the safe domain. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that all recruitment checks are carried out and recorded as part of the staff recruitment process, including a risk assessment as to which staff required a criminal records check with the disclosure and barring service (DBS).

We undertook this announced focused inspection on 8 December 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and is rated as good under the safe domain.

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

• The practice had reviewed their processes for the employment of staff and ensured that recruitment checks were carried out and all required information was recorded. This included, proof of identification including photo identification, references, full works history, signed confidentially forms and where required disclosure and barring checks (DBS). We saw that risk assessment had also taken place to review whether a DBS check was required for individual staff members.

We also received concerns raised by patients in relation to access to GPs. We spoke with the two GP partners about this. They were able to explain they had difficulties in recruiting and retaining GPs, this was partly due to many GPs not wishing to work full time. In response to this the GPs had come up with several initiatives to ensure that extra GPs had been recruited and that patients had timely access to emergency appointments and GP appointments.

Initiatives included:-

• Creating an on the day urgent care centre at Giggs Hill. Patients who required an on the day emergency appointment were given a two hour sit and wait time slot either in the morning or afternoon to see the Advanced Nurse Practitioners (who had support from the duty GP). The practice had plans to ensure that urgent care would also be provided from Glenlyn each morning, Monday to Friday after acting on comments from the patient participation group (PPG).
• Having a daily Administration GP assigned, which covered both Glenlyn and Giggs Hill. This role meant that all prescriptions, test results, calling patients for reviews etc. and administrative duties for all GPs were covered by a single GP. This ensured that any administration duties for GPs would not be delayed and the practice had been able to employ more GPs including those who wished to work part time. Patient prescription requests were completed in a timely fashion and the Administration GP had more time to review test results and decide on next actions to take for patients.
• Having a Duty GP which covered both Glenlyn and Giggs Hill. The duty GP had a slightly lighter patient list for the day to be able to support the advanced nurse practitioners and to take urgent phone appointments and could be called upon to help with enquiries from staff or other GPs.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Glenlyn medical Centre on our website at www.cqc.org.uk.

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 of this practice on May 2015. During this inspection a breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breach. After that inspection we received concerns regarding the main surgery and more specifically the newly required branch surgery Giggs Hill in relation to:-

• Patients waiting for repeat prescriptions

• Results not being reviewed in a timely manner

• Inadequate number of doctors on duty

• INR clinics being cancelled

• Phlebotomist extending their role with no training

As a result we undertook a focused inspection to look into those concerns and to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Glenlyn medical Centre on our website at www.cqc.org.uk.

We carried out an unannounced responsive inspection at Glenlyn Medical Centre and its branch surgery Giggs Hill on 21 January 2016.

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

• The branch surgery and main practice were acting as one. Therefore patients were able to access appointments at both locations. The practice had recently merged the two patients lists and the computer system. The phone lines were due to be transferred to one number in the next few weeks so calls would be taken from one location.
• We reviewed the repeat prescribing system and saw that GPs were signing repeat prescriptions that had been requested from the previous day. On average patients waiting 48 to 76 hours for repeat prescriptions.
• We were able to review the computer system to review test results and saw that these were reviewed in a timely manner and where necessary patients were contacted either the day the results were reviewed or the day after if further investigation was needed.
• The practice was aware that due to the takeover of Giggs Hill that a number of staff at this practice had resigned. The partners were actively advertising and employing staff members. Patients were being offered appointments at both locations while key staff were being employed and / or inducted at Giggs Hill.
• We reviewed the clinics listed for the INR clinics going back three months from October to December 2015 and found that during that time only one clinic had been cancelled.
• We found that no staff had the sole role as phlebotomist and instead were employed as Health Care Assistants (HCA). Staff we spoke with and evidence we saw showed that staff had been trained to take on all the duties they performed.

The areas where the provider must make improvement are:

• Ensure that all recruitment checks are carried out and recorded as part of the staff recruitment process as specified under schedule 3 of the Health and Social Care Act. And ensure when employing locum staff that identity checks are performed and staff are given an induction to the practice.

The provider should:

• Continue to review and implement improvements to patients’ access to the practice including monitoring the number of GP and nurse appointments available.

• Continue to ensure that all staff are informed of changes happening within the practice.

• Ensure that patients are made aware of changes happening within both locations.

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 of this practice on May 2015 and a focused inspection in January 2016. During both inspections we found the same breach of legal requirement and the provider was rated as requires improvement under the safe domain. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that all recruitment checks are carried out and recorded as part of the staff recruitment process, including a risk assessment as to which staff required a criminal records check with the disclosure and barring service (DBS).

We undertook this announced focused inspection on 8 December 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and is rated as good under the safe domain.

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

• The practice had reviewed their processes for the employment of staff and ensured that recruitment checks were carried out and all required information was recorded. This included, proof of identification including photo identification, references, full works history, signed confidentially forms and where required disclosure and barring checks (DBS). We saw that risk assessment had also taken place to review whether a DBS check was required for individual staff members.

We also received concerns raised by patients in relation to access to GPs. We spoke with the two GP partners about this. They were able to explain they had difficulties in recruiting and retaining GPs, this was partly due to many GPs not wishing to work full time. In response to this the GPs had come up with several initiatives to ensure that extra GPs had been recruited and that patients had timely access to emergency appointments and GP appointments.

Initiatives included:-

• Creating an on the day urgent care centre at Giggs Hill. Patients who required an on the day emergency appointment were given a two hour sit and wait time slot either in the morning or afternoon to see the Advanced Nurse Practitioners (who had support from the duty GP). The practice had plans to ensure that urgent care would also be provided from Glenlyn each morning, Monday to Friday after acting on comments from the patient participation group (PPG).
• Having a daily Administration GP assigned, which covered both Glenlyn and Giggs Hill. This role meant that all prescriptions, test results, calling patients for reviews etc. and administrative duties for all GPs were covered by a single GP. This ensured that any administration duties for GPs would not be delayed and the practice had been able to employ more GPs including those who wished to work part time. Patient prescription requests were completed in a timely fashion and the Administration GP had more time to review test results and decide on next actions to take for patients.
• Having a Duty GP which covered both Glenlyn and Giggs Hill. The duty GP had a slightly lighter patient list for the day to be able to support the advanced nurse practitioners and to take urgent phone appointments and could be called upon to help with enquiries from staff or other GPs.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Glenlyn medical Centre on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This was a follow up inspection to check that the provider had made improvements in the areas infection control, safeguarding and staff training and appraisal.

We looked at infection control procedures and saw that these were in place. Staff told us that they had received training in how to prevent the spread of infection.

We checked training records and saw that staff had received training in child protection and safeguarding vulnerable adults. Staff confirmed this when we spoke with them.

Staff told us that they had received a recent appraisal and that training had been provided to help them carry out their role, such as basic life support. We saw records that confirmed this.

During our inspection we spoke to six patients and eight members of staff and made some observations. We saw that staff treated patients with respect throughout the day. Patients told us “The staff are very helpful” and “I feel very respected by staff”.

Patients told us that they felt informed during their consultations and that they were able to make informed decisions about their treatment. One patient told us “I get good information. I feel well cared for here”.

Patients told us they felt safe at Glenlyn Medical Centre. However, we noted that staff had not received training in safeguarding vulnerable adults or child protection and not all staff were aware of the reporting procedures if they had a safeguarding concern.

We saw that the practice was clean, tidy and well organised and infection control procedures were in place. However, we noted that staff had not received training in infection control and procedures were not always followed.

Most staff told us they felt supported. However, we noted that staff training was not up to date and staff told us they did not receive regular supervision and appraisals. This was confirmed when we looked at staff records. The provider told us that they had staff records and would send these to us following our inspection. However, we did not receive these so could not include them in our report.

There was an effective complaints procedure in place and complaints were responded to according to the provider’s policy.