Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pennine Drive Surgery on 27 July 2016. The overall rating for the practice was good with safe rated as requires improvement. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Pennine Drive Surgery our website at www.cqc.org.uk.

This focused inspection was carried out on 10 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 27 July 2016. 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:

• PGD’s (Patient Group Directions) had been reviewed, signed and authorised in accordance with local and national guidelines for all nurses administering medicines at the practice.

• Training records including copies of all mandatory training conducted by staff outside of the practice had been maintained in staff records

• The practice had made further progress in developing quality outcome audits to ensure they were reflecting improvements over time.

• The practice had developed arrangements for monitoring the use of prescription pads in accordance with national NHS guidelines.

• Arrangements for staff appraisal had been reviewed to ensure that staff received an annual appraisal of their performance. The new system ensured that staff had their learning and development needs identified, planned and supported.

• The practice had progressed plans to audit patient consent to ensure consent recording practices were robust throughout the practice.

At our previous inspection on 27 July 2016, we rated the practice as requires improvement for providing safe services as the practice had failed to ensure that PGD’s (Patient Group Directions) were reviewed, signed and authorised in accordance with local and national guidelines for all nurses administering medicines at the practice (a Patient Group Direction (PGD) is a written instruction for the sale, supply and/or administration of medicines to groups of patients who may not be individually identified before presentation for treatment). At this inspection we found arrangements for PGD’s were robust and reflective of local and national guidelines. Consequently, the practice is rated as good for providing safe services.

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 Pennine Drive Surgery on 27 July 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. However, PGD’s (Patient Group Directions) had not been reviewed, signed and authorised in accordance with local and national guidelines for all nurses administering medicines at the practice. The process for overseeing the management of PGD’s required review to ensure that all nurses were authorised to administer medicines in line with legislation.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Implement an effective system around authorisation of PGD’s to ensure they are in place for all practice nursing staff including practice nurse locums. Ensure PGD’s (Patient Group Directions) are reviewed, signed and authorised in accordance with local and national guidelines for all nurses administering medicines at the practice.

The areas where the provider should make improvement are:

• Ensure training records include copies of all mandatory training conducted by staff outside of the practice..

• Review arrangements in relation to quality outcomes audits to ensure they are reflecting improvements over time.

• Review arrangements for monitoring the use of prescription pads in accordance with national NHS guidelines.

• Ensure that all staff receive an annual appraisal of their performance to ensure they are appropriately skilled and trained and that their learning and development needs are identified, planned and supported.

• Consider conducting a patient consent audit to ensure consent recording practices are robust throughout the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

When we inspected on 06 May 2014, the provider was unable to evidence that infection control risk assessments had taken place to determine frequency and intensity of cleaning. Subsequently, there was no cleaning schedule in place to guide cleaning staff on frequency and intensity or to record when and how specific areas had been cleaned. Also, cleaning equipment was not colour coded according to the area of usage. This meant that the provider was failing to comply with the requirements of Regulation 12(1) (2)(a)(c)(i) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take action.

When we inspected the practice again on 26 June 2014, we found that the provider had undertaken an infection control risk assessment and introduced a cleaning schedule determining cleaning frequency, intensity and allowing a cleaning record to be made of specific areas. Colour coded cleaning equipment had also been purchased. The action taken by the provider was sufficient to comply with the requirements of the regulation.

Patients who used the service were given appropriate information and support regarding their care and treatment. Latest patient survey results showed that most patients rated explanations from their doctor as either “excellent” or “very good.”

Patient’s care and treatment reflected relevant research and guidance. We saw evidence that the practice manager regularly received NHS guidance updates and that these were forwarded to staff.

Provider records showed that an infection control audit had taken place in February 2014 and that subsequent infection control/prevention measures had been implemented. However, the provider was unable to evidence that risk assessments had been undertaken to determine cleaning frequency and intensity.

Patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The provider’s emergency drugs were accessible and their expiration dates regularly checked.

Patients were asked for their views about their care and treatment and they were acted on. We spoke with a member of the practice’s Patient Group. They spoke positively about patient involvement and how the views of the group had been taken on board.