This practice is rated as requires improvement overall. (Previous rating–September 2017 Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Primary Care Today Ltd on 25 July 2018 in response to concerns.

At this inspection we found:

• The practice did not have clear systems to assess and manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had identified that some staff were not up to date with refresher training, an online training package had been purchased to improve this and additional training was scheduled.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• The practice had been without a practice manager between December 2107 and May 2018. The new practice manager had reviewed areas such as use of IT systems, training and appraisal and policies and procedures and implemented changes to improve these systems. During the inspection there was difficulty locating some of the records such as health and safety risk assessments and complaints records. Since the inspection the manager has provided evidence of action taken in response to health and safety matters.
• There was evidence of continuous learning and improvement at all levels of the organisation.

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

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Obtain evidence of satisfactory conduct from the practice managers previous employer.

I

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection at Primary Care Today Ltd on 21 February 2019 as part of our inspection programme.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 25 July 2018.

At the last inspection on 25 July 2018 we rated the practice as requires improvement overall and for providing safe and well led services because:

• Assessments of the risks to the health and safety of service users of receiving care or treatment were not being carried out.
• Shortfalls in infection prevention and control (IPC) had not been identified and addressed.
• Not all staff had completed refresher training in emergency procedures in the last 12 months.
• Emergency equipment was not checked in line with Resuscitation Council UK guidance.
• There had been previous shortfalls in monitoring vaccine fridge temperatures which had not been acted on appropriately.
• Staff received safeguarding and safety training appropriate to their role but not all staff had completed up to date refresher training in these areas.
• There were no records to evidence action taken in respect of external safety events and patient and medicine safety alerts.
• Equipment safety checks such as portable appliance testing checks were overdue.
• Complaints records had not been maintained.

At this inspection, we found that the provider had satisfactorily addressed these areas.

We based our judgement of the quality of care at this service is on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider

should

make improvements are:

• Review and improve processes for implementing appropriate authorisations for staff to administer medicines (including Patient Group Directions or Patient Specific Directions).
• Review and improve processes to monitor patients on high risk medicines.
• Review and improve accessibility to emergency medicines.
• Consider historical medicine safety alerts in when performing medicine reviews.
• Review and improve process for sharing information about current evidence based practice between staff.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Primary Care Today Ltd on 8 November 2016. The overall rating for the practice was Good but with Requires Improvement for safety. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Primary care Today Ltd on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 November 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:

• The provider had ensured all areas of the practice were clean and well maintained. The nurse’s treatment room had been refurbished since the last inspection. Standards of cleaning had been monitored to ensure all tasks were undertaken in line with the cleaning schedule.

• The chaperone policy and procedure had been reviewed and further developed to include arrangements and expectations relating to recruitment checks and requirement for staff to record chaperoning in patient records, although the requirement for staff to have received training in this area had not been included.

• Storage of blank prescriptions in printers overnight had been reviewed and improved in line with the NHS Protect guidance.

• Records were available to confirm that all staff had completed regular training in resuscitation to the level appropriate to their role.

• Systems had been implemented to record discussions at all practice meetings.

• Prior to the inspection we identified from 2016/17 data the practice had below average cancer referrals. We looked at this as part of the inspection and found the practice had put systems in place to improve.

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 Primary Today Care Ltd on 13 April 2016. Overall the practice was rated as requires improvement and breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulation 12, safe care and treatment, Regulation 18, Staffing and Regulation 19, fit and proper persons employed.

We undertook this comprehensive inspection on 8 November 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Primary care today Ltd, on our website at www.cqc.org.uk. Overall the practice is rated Good.

The provider had implemented a number of improvements recommended at the last inspection for example they had;

• Reviewed and improved procedures to ensure action was taken in response to medical alerts.

• Where audits had been completed action had been taken to address shortfalls identified in a timely manner commensurate with risk. They had put processes in place to monitor and ensure staff were aware of the procedures to take in the event of a fire.
• Taken action to minimise the risk of serious injury due to entanglement in blind cords.
• Reviewed and improved arrangements for the storage of vaccines to ensure these were in line with the Public Health England (PHE): Protocol for ordering, storing and handling vaccines, March 2014.
• Reviewed the control measures and procedures in place to ensure these were adequate to minimise the risk of legionella.

• Put procedures in place to ensure Patient Group Directions were authorised by the GP.

• Put procedures in place to monitor completion of mandatory and role-specific training. They had ensured staff training for those undertaking vaccines and immunisations was up to date.

• Taken action to obtain written information relating to a person’s character and previous conduct, such as references.

The provider had also taken action in the following areas where we had advised them they should make improvement:

• Records now identified the level of safeguarding children training staff had received.

• Staff had an understanding of the electronic patient records where this related to identifying vulnerable patients.

• They had put procedures in place to ensure staff who undertake chaperone duties were trained for this role. However, the training was not recorded in staff training records.

• They had ensured clinical staff were aware of relevant guidance for assessing competence to make a decision when providing care and treatment for children and young people.

• They had provided additional equipment for the defibrillator to enable this to be used for children.

• They had provided patients with information on how to escalate their complaint if they are not happy with the response from the practice.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The risks to patients were assessed but processes relating to cleanliness and maintenance of the environment required improvement.
• Staff had received training to provide them with the skills, knowledge and experience to deliver effective care and treatment. ELearning was provided for mandatory training. Systems were in place to monitor training and training was scheduled.
• 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 audits, surveys, 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 although procedures to support this were not included in the incident reporting procedures.

The areas where the provider must make improvement are:

• Ensure all areas of the practice are maintained in a clean and well maintained condition. Monitor cleaning to ensure all tasks are undertaken as per the cleaning schedule.

The areas where the provider should make improvement are:

• Review the chaperone policy and procedure and further develop to include arrangements and expectations relating to recruitment checks, staff training and patient records.

• Review storage of blank prescriptions in printers overnight in line with the NHS Protect guidance

• Review the process for recording issues discussed and action points at all practice meetings .

• Maintain records to confirm that all staff have completed regular training in resuscitation of both adults and children to the level appropriate to their role.

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 Primary Today Care Ltd on 13 April 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The risks to patients were assessed but processes relating to management of health and safety matters required improvement.
• Staff had received some training to provide them with the skills, knowledge and experience to deliver effective care and treatment. Systems were not in place to monitor and ensure all the clinical team were up to date with training and relevant good practice guidance.
• 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 audits, surveys, 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. Systems and processes had been reviewed and improved over the last 12 months although some areas required further development and improvement.
• 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:

• Review procedures to ensure action is taken in response to medical alerts.
• Where health and safety audits have been completed ensure action is taken to address shortfalls identified in a timely manner commensurate with risk. Put processes in place to monitor and ensure staff are aware of the procedures to take in the event of a fire.
• Implement the Department of Health guidance February 2015 relating to blinds and blind cords to minimise the risk of serious injury due to entanglement.
• Put procedures in place to ensure Patient Group Directions are authorised by the GP.
• Put procedures in place to monitor and ensure mandatory and role-specific training and updating for staff is undertaken.
• Ensure the practice recruitment policy is implemented consistently. Ensure written information relating to a person’s character and previous conduct, such as references, is obtained prior to employment.

The areas where the provider should make improvement are:

•  Reflect the relevant level of safeguarding children training staff have received in records.
• All staff should have an understanding of the electronic patient records where this relates to identifying vulnerable patients.
• Review the chaperone policy and procedure and update to include arrangements and expectations relating to recruitment checks, staff training and patient records.
• Keep all areas in the practice clean and tidy.
• Review arrangements for the storage of vaccines so these are in line with the Public Health England (PHE): Protocol for ordering, storing and handling vaccines, March 2014. Put arrangements in place so the fridge used for storage of vaccines, which is not wired into a switchless socket, cannot be switched off accidentally. Review arrangements for monitoring the temperature of the vaccine fridge in relation to the provision of thermometers.
• Review the control measures and procedures in place so these are adequate to minimise the risk of legionella.
• Review the arrangements for provision of emergency equipment in relation to children’s pads for the defibrillator.
• Give patients access to information on how to escalate their complaint if they are not happy with the response from the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice