Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rainbow Surgery on 13 September 2016. The overall rating for the practice was good, with requires improvement for the safe domain. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Rainbow Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 February 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 13 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had obtained a new medicine refrigerator. Records of medicine refrigerator temperatures were being appropriately completed. Written procedures were amended to reflect the correct temperature range for the storage of medicines requiring refrigeration.

• Controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse) were being monitored weekly in line with published guidance. However, the provider informed us that the practice no longer intended to keep higher scheduled controlled drugs.

• The practice had considered the risks around the open-plan nature of the dispensary and taken action to the raise awareness of staff about the risks of non-authorised access to medicines. This was to be reviewed annually. Medicine stock-takes were in place which would highlight medicine discrepancies if they occurred.

• The practice had put in place systems which included a written procedure to ensure there was written authorisation in place for the administration of medicines such as injectable vitamin B12 and influenza vaccines by nursing and healthcare staff.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Continue to risk assess and monitor arrangements in place for the security of medicines in the dispensary area.

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 Rainbow Surgery on 13 September 2016. Overall the practice is rated as good.Our key findings across all the areas we inspected were as follows:

• The practice had systems in place for reporting and recording significant events.

• Although risks to patients who used services were assessed, the systems and processes to address these risks were not robust enough to ensure patients were kept safe. For example, risk assessments for access to the dispensary for those who are not involved in the dispensing process and the risks associated with the appropriate storage of medicines. There was scope to improve the process in place for undertaking and recording of stock checks of controlled drugs at the practice.
• 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. However, there was scope to improve the competence of staff who worked in the dispensary.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. 94% of patients described the overall experience of this GP practice as good compared to the CCG average of 86% and the national average of 85%.
• 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. 99% of patients said they could get through easily to the practice by phone compared to the CCG average of 75% and the national average of 73%.
• 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 areas of outstanding practice:

• The practice had set up stroke, dementia and Parkinson’s support groups, an armchair exercise group and a men’s weight reduction group. The men’s weight reduction group had six members at the time of our inspection with a reported average of seven pounds in weight loss per member since December 2015. The practice provided these groups for the whole community in addition to their own patients.
• Families affected by alcohol abuse were also provided with on-going support and were referred to a service initiated by the practice seven years ago and now available to all 27 practices in the area. We were told this work had won three national awards including the British Medical Journal Primary Care Team of the Year award 2011/12.

The provider must:

• Ensure that, where the administration of medicines is not covered by a valid Patient Group Direction, staff have authorisation from a prescriber for individual patients before administering medicines.
• Improve the arrangements for the safe storage of medicines including;

  • Making regular checks on Controlled Drugs stock in line with regulations.
  • Ensuring that medicines which require refrigeration are stored at temperatures between 2⁰ and 8⁰C in line with manufacturers’ recommendations.
  • Reviewing the arrangements for storing medicines so that they are accessible by authorised staff only.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice