Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Hollinswood and Priorslee Medical Practice on 4 February 2016. The overall rating for the practice was Good, with the Well Led key question being rated as Requires Improvement. We found one breach of a legal requirement and as a result we issued a requirement notice in relation to:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance.

The full comprehensive report from the inspection on the 4 February 2016 can be found by selecting the ‘all reports’ link for Hollinswood and Priorslee Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 6 July 2017. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and improvements had been made to the system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients 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.
• Patients commented that there were challenges around making appointments. Patients said they did not always know which site to attend for their appointment and were unaware of the availability of extended hours appointments two evenings a week.
• 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. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were areas of practice where the provider should make improvements.

The provider should:

• Formalise and record clinical supervision which takes place between the nurse practitioner and GP.
• Obtain a Disclosure and Barring Service (DBS) check pertaining to the current employment for the Advanced Nurse Practitioner.
• Consider obtaining portable oxygen cylinders or a means of transporting the current cylinders around the building.
• Ensure all staff are up to date with their required training.
• Ensure that staff have access up to date policies that have been reviewed.
• Review the GP survey results and identify action to improve patient satisfaction scores for consultations and interaction with the GPs.

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 Hollinswood and Priorslee Medical Practice on 4 February 2016. Overall the practice is rated as Good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events, although it was not always used effectively. Minor incidents were discussed and appropriate action taken, but not recorded or discussed at the clinical meetings.
• The arrangements in place for identifying, recording and managing risks, issues and implementing mitigating actions were inconsistent across the three sites. For example risk assessments were not available for the Hollinswood and Priorslee premises (including fire risk assessments), there was no overarching plan for all three sites regarding a programme of infection control audits, the use of prescription forms and pads were not adequately monitored and significant events were not always recorded and discussed.
• 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.
• Patients said they were treated with compassion, dignity and respect 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.
• We observed that patients could usually get an appointment when they needed one, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There had been changes in the management structure following the merger and not all staff were clear about their roles and responsibilities. However, staff felt supported by the management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

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

Importantly, the provider must:

• Ensure the distribution and use of prescription pads and blank computer prescription forms is monitored for all branch practices.
• Develop a clear staffing structure so that all staff are clear about their roles and responsibilities.
• Review and revise the policies and procedures to reflect the working practices at all three sites to ensure consistency.
• Include all staff in discussions about how to develop the practice following the merger and enable them to identify areas for improvement.
• Implement systems for assessing and monitoring risks across all three sites.

In addition the provider should:

• Ensure that all significant events, incidents and near misses are recorded and discussed.
• Record the reason why the temperature of the vaccine refrigerator is ever outside of the normal range for short periods of time.
• Have an infection control audit programme in place at all three sites.
• Carry out regular fire drills.
• Record when each defibrillator is checked.
• Update the business continuity plan to reflect the changes in the structure of the organisation and include contact details for staff.
• Implement a system to ensure regular meetings are held within the practice and information discussed at meetings is shared with the appropriate staff members.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice