Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Morrab Surgery on 11 March 2015. There was one area followed up in a desktop reviewed on 26 November 2015. The overall rating for the practice was outstanding, with other ratings listed at the beginning of the report. The full comprehensive report can be found by selecting the ‘all reports’ link for Morrab Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 29 November 2018. The purpose of the inspection was to review actions taken by the practice to safeguard patients following a serious incident of fraudulent activity investigated by the police.

We did not rate the practice at this inspection. This will be reviewed at the next routine comprehensive inspection.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations. However, there were areas of governance where improvement was required. The practice demonstrated safeguards were now in place resulting from the serious incident: Limiting prescribing and issuing of scripts for medications by authorised clinical staff only. Increased security of prescription stationary was in place. Staff had a clear understanding of their roles and responsibilities regarding patient prescriptions.

Our key findings were:

• There was immediate notification and liaison with appropriate authorities (Care Quality Commission, NHS England and Nurses, Midwife Council) after the practice was made aware of unusual prescribing activity.
• Processes were put in place limiting access within the prescribing part of the patient record system to allow only authorised clinical staff who held a prescribing qualification to prescribe medicines.
• Duty of candour requirements were followed with affected patients being informed about the incident, with records of any actions taken.
• The practice worked closely with the police during their investigation and court case.
• Risk assessments were completed for additional prescription security and locks purchased for printers to secure prescription stationary.
• Gaps were seen in governance processes where mitigating actions to reduce risks had not been followed up. The practice did not have an effective audit system to determine whether improvements and changes made were embedded. A risk assessment covering prescription security and new procedures were written within 48 hours of the inspection covering authorisation and initiation of combined oral contraception, dispensary and reception tasks regarding acute prescriptions.
• An inconsistent approach was seen regarding which process should be followed for complaints and significant events, which could be confusing and affect the governance of these processes by the practice.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider could make improvements and should:

• Keep policies and procedures for prescribing management under review to ensure current best practice guidance is followed to reduce risks.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a desktop review of Morrab Surgery on 26 November 2015. This was to review the actions taken by the provider as a result of our issuing a legal requirement.

Overall the practice has been re-rated as OUTSTANDING following our findings.

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

• The provider had established and is operating effective recruitment procedures to ensure that information regarding pre-employment checks are kept regarding persons employed.

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 Morrab Surgery on 11 March 2015. The practice has a small branch surgery at Mousehole, where patients with minor concerns are seen. This inspection focussed on the Morrab Surgery. Overall the practice is rated as GOOD.

Specifically, we found the practice to be outstanding for caring and responsive services. The practice was good for providing effective and well led services, but required improvement to safety. It was good for providing services for older people, working age people and people with mental health needs including dementia and people with long term conditions. It was outstanding for and families, babies children and young people and vulnerable people.

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

• Patient contentment at Morrab Surgery was significantly higher with 100% expressing overall satisfaction with the practice. Patients they were treated with “exceptional” compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was a strong commitment to providing person centred, well co-ordinated, responsive and compassionate care for patients.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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. Urgent appointments were available the same day and staff were flexible and found same day gaps for patients needing routine appointments.
• 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.
• Audits were used by the practice to identify where improvements were required. Action plans were put into place, followed through and audits repeated to ensure that improvements had been made.
• The practice had clear policies and procedure providing guidance for staff. However, we found that the recruitment policy had not been adhered to and needed improvement.

We saw areas of outstanding practice including:

• The practice understood the needs of the patient list and the challenges of the coastal location and had developed a responsive service accordingly. There were many examples of this seen at the inspection. For example, Morrab Surgery is strongly committed to breaking down barriers for vulnerable people, including homeless people who are valued, made welcome and very well supported. Extended appointments were made available immediately so thorough health assessments of homeless people could be done and treatment provided where appropriate.

• Staff are consistent in supporting people live healthier lives through a targeted and proactive approach. For example, the practice is focussed on working with young people to reduce the number of unplanned pregnancies. The practice is an approved Young people friendly service and able to provide friendly, confidential support that is focussed on the needs of young people. Statistics for the practice showed that the number of unplanned births to women under 18 years had fallen slightly from 5 in 2010 to 2 in 2014 and 1 in 2015. A dedicated young person clinic is run once a week after school hours and information at the practice and website is aimed at young people providing contraception and sexual health advice, support and treatment.

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

Importantly the provider must:

Establish and operate effective recruitment procedures to ensure that information regarding pre-employment checks is kept.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice