This practice is rated as Requires Improvement overall. (Previous rating June 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Old Fletton Surgery on 25 September 2018. We inspected the practice as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. The practice was not proactive in identifying significant events. Three significant events had been recorded in the last 12 months. When incidents did happen, the practice did not always review and analyse the incidents so that they learned from them and improved their processes.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice had evidence of quality improvement with completed repeat cycle audits.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff were positive about working in the practice and felt valued and supported in their roles.
• There was an active Patient Participation Group that worked with the practice to provide support to the local community.
• The practice had identified 77 patients as carers which was approximately 0.6% of the practice patient list.
• At the time of our inspection 39% of patients over 75 years old had received an annual medicine review in the last 12 months. The practice recently employed a clinical pharmacist to assist in medicines reviews.
• The practice provided staff with some ongoing support. There was an induction programme for new staff. Support included one to one meetings, coaching and mentoring, clinical supervision and revalidation, however only the four nursing staff had received appraisals in the last two years.
• The practice did not have reliable systems in place to ensure prescriptions (pads and computer prescription paper) were monitored and secure.
• The practice had not completed and documented any fire drills. The practice advised that following the inspection they would commence annual fire drills.
• The practice did not have a satisfactory system in place for responding to safety alerts.
• A GP partner provided leadership around antibiotic stewardship. The practice had carried out prescribing audits to identify whether antibiotic prescribing was in line with national guidance when treating infections, however the practice had a high antibiotic prescribing rate and had recently employed a clinical pharmacist into the practice.
• Reception staff had not received training to ensure awareness of the signs of Sepsis. Following our inspection, the practice was organising online sepsis awareness training for non-clinical staff members.
• The practices performance on some quality indicators for mental health and long-term conditions was below the local and national averages. The practice had changed their lead for mental health within the practice since 2016/2017 however figures for 2017/2018 did not show a significant improvement for the mental health indicators and some long-term conditions indicators had declined, for example, hypertension and asthma.
• Not all clinicians had access to safeguarding flags on the clinical computer system.
• The practice did not always ensure changes to medicines from hospital letters were approved by a GP when completed.
• The practice held a range of emergency medicines and equipment however they had not completed an appropriate risk assessment.

The areas where the provider must make improvements as they are in breach of regulations are:

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

The areas where the provider should make improvements are:

• Review the process for prescribing antibiotics to conform with best practice.
• Provide awareness training for all staff on the ‘red flag’ sepsis symptoms that might be reported by patients and how to respond appropriately.
• Proactively identify carers on the practice patient list.
• Complete and record annual fire drills.
• Review the appraisals system to ensure all members of staff receive an appraisal at least annually.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Fletton Surgery on 8 March 2016. At this time we noted that improvement was required as systems and processes were required to ensure that clinicians were overseeing and checking changes to prescriptions.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to ensuring robust processes were in place.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link for on our website at www.cqc.org.uk

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 Old Fletton Surgery on 8 March 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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 very well 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 area where the provider must make an improvement is:

• Ensure that patients who are prescribed medicines that require specific monitoring are reviewed in line with national prescribing guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice