Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leyton Healthcare on 15 December 2016. The overall rating for the practice was good, with a rating of requires improvement for providing safe services. The full comprehensive report published in February 2017 can be found by selecting the ‘all reports’ link for Leyton Healthcare on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 8 August 2017, carried out 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 15 December 2016. There were breaches in staff training, medicines management and emergency procedures. There were also concerns with the identification of patient carers, the management of vaccines, the storage of blank prescription pads, procedures to deal with test results and the uptake of childhood immunisations.

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.
• The practice had clearly defined and embedded systems to minimise risks to patient safety, including a fire risk assessment and regular alarm testing and fire drills.
• All staff members had completed training relevant to their role including, including fire safety awareness and infection prevention and control.
• The practice had increased its number of carers from 43 at our last inspection to 57 (less than 1%), and were proactively working on increasing this further.
• The practice had good arrangements to deal with medical emergencies, including on site emergency equipment such as a defibrillator and oxygen cylinder that was checked weekly to ensure it was in good working order.
• Patient Group Directions (PGD) had been adopted by the practice to allow nurses to administer medicines in line with legislation.
• Blank prescription pads were securely stored in a locked cabinet and there was a system for monitoring there use.
• Vaccines were stored in two fridges to ensure adequate air circulation and fridge temperatures were monitored twice daily.
• There was a policy and failsafe to manage incoming test results.
• We were provided with evidence that childhood immunisation rates were comparable with national averages.
• The practice was actively promoting the uptake of cancer screening.

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

Importantly the provider should:

• Continue to work to increase the uptake of cancer screening.
• Continue to work to increase the number of patient carers to ensure that adequate information and support is provided to them.

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 Leyton Healthcare on 15 December 2016. Overall the practice is rated as good.

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

• We found that some non-nursing staff administering vaccines and immunisations had not been authorised to do so in that required patient specific directions had not been signed by a GP.
• The practice was located on the fourth floor of a shared building but the lift to the surgery was prone to malfunctioning.
• There was no written procedure in place to manage medical emergencies at the practice, for instance, regular checks of oxygen cylinders were not undertaken.
• Most risks to patients were assessed and managed but there were gaps.
• Most staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment however, training in fire safety awareness and infection prevention and control had not been undertaken by all staff.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments 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. 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 areas where the provider must make improvement are:

• Put a process in place to risk assess and manage medical emergencies at the practice, including regular checks of oxygen cylinders to ensure they are fit for purpose when required.
• Ensure that non-nursing staff responsible for administering vaccines and immunisations are properly authorised to so, by putting in place valid patient specific directions which have been signed by a GP.
• Ensure that all staff receive appropriate training on fire safety awareness and infection prevention and control.

The areas where the provider should make improvement are:

• Ensure blank prescriptions pads and printer stationary are handled in accordance with national guidance and that stock levels of handwritten prescription pads reflect the needs of the practice.
• Review arrangements for managing vaccines to ensure that there is sufficient capacity to store stock safely and ensure that fridge temperatures are closely monitored.
• Put in place a policy to govern the management of pathology tests and results to ensure that all staff follow consistent procedures.
• The practice should review the current uptake for childhood immunisations and cancer screening programmes among eligible patients with a view to improvement.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to all.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice