Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Loomer Road Surgery on 10 January 2017. The overall rating for the practice was requires improvement with inadequate for providing safe services and requires improvement for providing well led services. The full comprehensive report on the 10 January 2017 inspection can be found by selecting the ‘all reports’ link for Loomer Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 19 July 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the provider was not always aware of incidents they needed to report to the Care Quality Commission.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice had developed the role of the Elderly Care Facilitators to bridge the health and social support for older and frail patients.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. The provider had reviewed the arrangements for medicines carried in GP bags for home visits. A risk assessment had been completed and a decision made not to carry any emergency medicines on GP home visits. However, the risk assessment did not consider all eventualities of how risk was mitigated for each individual emergency condition.
• 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 published in July 2017 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Some patients commented on the difficulty of accessing appointments especially at the branch practice. Results from the national GP patient survey supported these findings.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff spoke very highly of the support from the management.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice’s vulnerable adults safeguarding policy and the cold chain policy did not always reflect up to date guidance.
• An active and effective patient participation group had not been established at the practice to support patient feedback.
• The provider had introduced a varied skills and workforce mix within the practice to help to meet the health and social needs of patients.

There were areas of practice where the provider needs to make improvements.

The provider should:

• Review the Care Quality Commission (Registration) Regulations 2009 to support their understanding of incidents that are notifiable to the Care Quality Commission.

• Update the vulnerable adults safeguarding policy to reflect updated categories or definitions of the types of abuse for example, modern slavery. Update their cold chain policy to provide clear guidance on the transport of flu immunisations when providing offsite immunisations.

• Continue to ensure that appropriate decisions are made when exception reporting patients from the Quality and Outcomes Framework calculations.

• Continue to monitor and review patient access to appointments.

• Explore and implement ways to establish an active and effective patient participation group.

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 the Loomer Road Surgery on 10 January 2017. Overall, the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and the practice had a system for reporting and recording significant events, and learning from them. There was a system for dealing with safety alerts and sharing these with staff. However, the practice did not maintain a log of the actions they had taken in response to safety alerts.

• The risks associated with foreseeable events and emergency situations were not always clearly identified.

• The systems for managing risks to patient safety were not always sufficiently thorough.

• The practice’s governance arrangements did not always operate effectively. In particular, there was a lack of oversight of some of the practice’s systems and processes for ensuring patient safety.

• Staff were very committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• Staff assessed patients’ needs and delivered care and treatment in line with current evidence based guidance.

• The practice worked with other organisations when planning how services were provided, to ensure patients’ needs were met. The provider was proactive in planning and providing services to meet the needs of older patients. They had set up an Elderly Care Facilitators Team (ECFT), to carry out comprehensive assessments of older patients in their own homes. Between September 2016 and January 2017, the ECFT had visited 196 patients aged over 85 years of age. This service was over and above what was expected and had improved outcomes for this group of patients.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a strong focus on service development aimed at improving the patient experience. However, the provider’s focus on making improvements and managing change across their primary medical services, as well as the challenges associated with taking on a new practice and providing support to other local practices, in collaboration with NHS England, may have contributed to some of the concerns we identified in relation to governance.

• Information about services and how to complain was available and easy to understand.

There was an area of practice where the provider must make improvements:

The provider must assess, monitor and improve the quality and safety of the services provided, in particular, the arrangements for:

• Fire safety.

• Amending prescriptions.

• Ensuring clinical equipment is fit for purpose.

• Ensuring staff have completed appropriate training.

• Recording and reviewing minor surgery.

The provider must ensure the proper and safe management of medicines, in particular, with regard to the arrangements for:

• Checking the expiry dates of equipment kept in the anayphylactic box.

• Making changes to patients’ prescriptions, including adding additional items.

• Making sure a stock of atropine is always available for use in an emergency.

There were also areas where the provider should make improvements. The provider should:

• Carry out a risk assessment in relation to the decision that GPs will not carry a range of emergency medicines for use in acute situations, when on home visits. Keep a written record of this risk assessment.

• Develop targeted improvement plans to address those Quality and Outcomes Framework exemption reporting rates which are higher than the local clinical commissioning group and national averages. In addition, develop a targeted improvement plan to increase the uptake of bowel and cervical screening.

• Continue to monitor the effectiveness of the appointment system

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice