Letter from the Chief Inspector of General Practice

We carried out a desk top review of Pinhoe Surgery on 1 August 2016. This review was performed to check on the progress of actions taken following an inspection we made on 28 November 2015. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet the breaches in regulation. During our latest Inspection on 1 August 2016 we found the provider had made the required changes.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published on 3 March 2016. This can be done by selecting the 'all reports' link for Pinhoe Surgery on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

• The practice had improved health and safety for patients by implementing robust arrangements for managing medicines, including vaccines, in regard of their recording, handling, storing and security.

• Improvements to patient safety had been made by ensuring robust arrangements were in place for Patient Group Directions. These had been adopted by the practice to allow nurses to administer medicines in line with legislation..

• The practice had improved health and safety for patients by implementing safe infection control procedures including an audit of all areas, updating the infection control policy and protocols. All clinical staff had training updates planned to reinforce the measures already taken.

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 The Pinhoe and Broadclyst surgery on 24 November 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and an effective 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.
• Risks to patients were assessed and well managed, with the exception to the storage of vaccinations, the security of blank prescriptions and the appropriate use of patient group directives by nurses.
• 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 provider was aware of and complied with the requirements of the Duty of Candour  

We saw several areas of outstanding practice - The practice was well led and responded to patient need and feedback. Innovative and proactive methods were used to improve patient outcomes even where no financial incentives or contractual agreements were expected:

• The practice nurses performed complex leg ulcer dressings in the practice following extended training at the local hospital with community nurses specialising in tissue viability. The practice nurses had also worked with the dermatology department at the local acute trust to obtain training and advice. Pinhoe Surgery staff input meant patients were able to receive this complex treatment at the practice avoiding the need to attend the community leg ulcer clinic on the other side of the city.

• An additional service was provided by staff at the practice for patients with indwelling intravenous lines used for prolonged treatments such as chemotherapy, long term antibiotics and intravenous feeding. Patients were normally required to go to hospital for management of this intravenous line. However, staff at the practice had completed extended training to enable patients to receive care locally, at the practice.

However there were areas of practice where the provider must make improvements:

• Urgently review the arrangements for the storage of vaccines in the practice

• Review arrangements for prescribing under Patient Group Directions to ensure all meet current legislation and are authorised for use in the practice

• Review procedures for storing and recording blank prescriptions to ensure national guidance is followed

  Complete a risk assessment re vaccine storage fridges and reduce or remove the risk of storage at temperatures outside of the safe range.

• Improve infection control procedures including an audit of all areas, infection control policy and protocol updates and all required staff to be trained to an appropriate level.

In addition the provider should

• Ensure all appraisals are up to date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice