Letter from the Chief Inspector of General Practice

We carried out a focused follow up inspection of North Harbour Medical Group on 8 November 2016. This inspection was performed to check on the progress of actions taken following an inspection we made on 1 March 2016. These included;

• A lack of governance arrangements in the practice for the administration of vaccines under patient group directions (PGD) to ensure staff were competently trained and that the PGD was completed in a timely manner to ensure nurses did not practice outside of the legal framework.
• A lack of systems to ensure the practice was able to respond to medical emergencies. Specifically, improving the processes for managing emergency medicines, defibrillator, oxygen cylinders and labelling of the anaphylaxis medicines kit to minimise risks.
• A need to improve governance arrangements for prescription tracking and monitoring.
• The provider should raise awareness of the number of carers on the practice carer’s register.

Following the inspection in March 2016 the provider sent us an action plan which detailed the steps they would take to meet their breaches of regulation. During our latest inspection on 8 November 2016 we found the provider had made the necessary improvements in delivering safe, well led services.

This report covers our findings in relation to the requirements and should be read in conjunction with the comprehensive inspection report published in May 2016. This can be done by selecting the 'all reports' link for North Harbour Medical Group on our website at www.cqc.org.uk

Our key findings across the areas we inspected in this focused follow up inspection were as follows:

• There were now well organised governance arrangements in place for the administration of vaccines under patient group directions (PGD) to ensure staff were competently trained and that the PGDs had been completed in a timely manner.
• Systems were now in place to ensure the practice was able to respond to medical emergencies.
• Improved governance arrangements for prescription tracking and monitoring were in place in line with guidance from NHS Protect.
• The provider had raised awareness of the number of carers on the practice carer’s register and their numbers had increased accordingly.

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 North Harbour Medical Group on 1st March 2016. Overall the practice is rated as requires improvement.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, the practice could not demonstrate they were able to respond to medical emergencies. The checking systems for emergency medicines were not effective at identifying expired medicines or equipment. The practice system for monitoring patient group directions (PGDs) did not ensure that nurses were competent to give vaccines, therefore putting patients at risk.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• 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. 92% of patients said they always or almost always see or speak to the GP they prefer (CCG average 59% and national average 59%).
• 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 a leadership structure, but we found limited formal governance arrangements affecting the implementation of policies and lack of inclusion of nursing staff.
• Staff felt supported by management. The practice 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 practice actively managed an on the day appointment system for each GP. This provided patients with access to their named GP when they needed it.
• The impact of this was that every patient knew their named GP would usually be available to see or speak to on the same day.

The areas where the provider must make improvement are:

• Improve governance arrangements in the practice for the administration of vaccines under patient group directions (PGD) to ensure staff are competently trained and that the PGD is completed in a timely manner to ensure that nurses do not practice outside of the legal framework.

• Implement systems to ensure the practice is able to effectively check the equipment related to managing medical emergencies. Specifically, improve the processes for checking emergency medicines, defibrillator, oxygen cylinders and labelling of the anaphylaxis medicines kit to minimise risks.

• Improve governance arrangements for prescription tracking and monitoring.

The area where the provider should make improvements are:

• The practice should aim to increase awareness of the number of carers on their register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice