Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Field Surgery on 29 October 2015 and an announced focused inspection on 24 January 2017. After the January 2017 inspection we received concerns in relation to medicines management in the practice. As a result we undertook a focused inspection to look into those concerns on 5 December 2017. This report only covers our findings in relation to this topic. You can read the reports from our last inspections by selecting the ‘all reports’ link for Manor Field Surgery on our website at www.cqc.org.uk.

Our key findings were as follows:

• The provider had responded to concerns raised with them about medicines management. All systems relating to medicines management had been reviewed and improved in response to the concerns raised.

• The practice had reliable systems for appropriate and safe handling of medicines.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Field Surgery on 29 October 2015. The overall rating for the practice was good but with requires improvement for safety. The full comprehensive report for the 29 October 2015 inspection can be found by selecting the ‘all reports’ link for Manor Field Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 January 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 29 October 2015. 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:

• Systems were in place to monitor the use of medicines in the practice.

• A system had been developed and implemented to ensure that action was taken in response to medical alerts and a log had been maintained to monitor this. Clinical staff were made aware of the alerts they were aware how these had been actioned.

• A significant event log had been developed to ensure outcomes had been achieved.

• Improved systems had been implemented to ensure blank prescriptions were held in line with NHS Protect Security of Prescription Forms Guidance although the security of blank prescriptions stored in printers required further review.

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 Manor Field Surgery on 29 October 2015. Overall the practice is rated as good.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However, a significant event log was not maintained to ensure outcomes had been achieved.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, systems to ensure the safe storage and use of medicines were not always implemented by GPs in respect of medicines held by them. There was no system in place to ensure that action was taken in response to medical alerts and a log was not maintained to monitor this.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 registered provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

The practice had taken a number of measures to ensure patients could access the surgery easily and to improve the range of services provided. The practice had introduced an increased number of health care assistant (HCA) hours over five days to provide more access to routine and urgent phlebotomy services and other procedures undertaken by the HCA. Patients could access a HCA from 8.00am to give more flexibility to patients who worked or who needed an early morning appointment. They told us they had found this beneficial for patients who required bloods to taken after a period of fasting.

The practice had a high prevalence of patients with respiratory conditions. A practice nurse had been recruited with skills in asthma and chronic obstructive pulmonary disease (COPD) to address lengthy waiting times for patients to see a respiratory nurse at secondary care services. Nursing hours had been extended to provide more late afternoon and evening surgeries over five days per week to give patients more choice of appointment time and to reduce the waiting time to see a nurse for respiratory reviews. The nurse practitioner was introducing additional minor illness clinics to complement the GP role by seeing patients with conditions within her remit which would otherwise have been seen by a GP.

Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was above local and national averages.

Patients told us that they found it easy to get appointments when they needed them. Parents said that the urgent services for children were very good and other patients said the telephone consultation service was also very good.

The areas where the provider must make improvement are:

• Medicines held by individual GPs were not always appropriately labelled or safely stored and records were not maintained for controlled drugs in line with the Misuse of Drugs Regulations 2001.

• There was no system in place to ensure that action was taken in response to medical alerts and a log was not maintained to monitor this. Although clinical staff were made aware of the alerts they were unsure how these were actioned.

The areas where the provider should make improvement are:

• A significant event log was not maintained to ensure outcomes had been achieved.

• Blank prescriptions were not held in line with NHS Protect Security of Prescription Forms Guidance 2013.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice