Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sheet Street Surgery on 7 April 2016. Overall the practice is rated as good.

Specifically, we found the practice to require improvement for provision of safe services. It was good for providing effective, caring, responsive and well-led services. 

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded, monitored and reviewed.
• Risks to patients and staff were assessed and well managed in some areas, with the exception of those relating to fire safety procedures, safeguarding training, care planning and prescription safety and security. For example, the practice did not have a fire safety policy in place, fire safety system was not serviced regularly and they were not carrying out regular fire safety checks and drills.
• We found that completed clinical audits cycles were driving positive outcomes for patients.
• 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. However, some staff had not completed health and safety, equality and diversity, fire safety and basic life support training.
• Patients we spoke with on the day informed us 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 were available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP, 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 improvements are:

• Ensure fire safety procedures and checks are fully implemented, and develop an action plan to address the issues identified during recent fire risk assessment.
• Ensure the process for the handling of blank prescription forms are handled in accordance with national guidance as these were not tracked through the practice and kept securely at all times.

In addition the provider should:

• Ensure all staff have undertaken training including safeguarding, health and safety, equality and diversity, fire safety, infection control and basic life support.

• Develop and implement a clear action plan, to improve the outcomes for patients with learning disabilities, patients experiencing poor mental health and patients at risk of unplanned admission.
• Encourage carers to register as such to enable them to access the support available via the practice and external agencies.
• Ensure partnership details are updated to the practice’s Care Quality Commission registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In April 2016, during our previous comprehensive inspection of Sheet Street Surgery, we found issues relating to the safe delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make further improvements; in order to ensure that fire safety procedures and checks are fully implemented. In addition the practice was asked to develop an action plan to address the issues identified during their most recent fire risk assessment.

We also found that the practice did not have an appropriate process for the handling of blank prescription forms. Furthermore, the practice needed to ensure that all staff had undertaken training including safeguarding, health and safety, equality and diversity, fire safety, infection control and basic life support.

We also found that the practice needed to develop and implement a clear action plan to improve the outcomes for patients with learning disabilities, patients experiencing poor mental health and patients at risk of unplanned admission. The practice also needed to encourage carers to register as such, in order to enable them to access the support available via the practice and external agencies.

Finally at our previous inspection, we also found that the practice needed to ensure partnership details are updated to the practices Care Quality Commission (CQC) registration.

Following the last inspection, the practice was rated as requiring improvement in safe services, and good for effective, caring, responsive and well led services. The practice had an overall rating of good.

We carried out a desk based inspection in November 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of fire policies and procedures, and documents relating to the tracking and monitoring of prescriptions, to demonstrate the range of improvements they had made, since our last visit. The practice also further supplied a chart outlining the areas the practice had attempted to improve and an updated staff training record document.

We found the practice had made improvements since our last inspection in April 2016.

At this inspection we found that:

• The practice had instructed an independent company to re-assess the risk of fire in the practice.

• The practice had reviewed and updated their fire policy.

• Improvements had been made to the processes used to handle blank prescriptions.

• Steps had been taken to address the security issues surrounding blank prescriptions.

• Systems were now in place to ensure the processes used to handle blank prescriptions were both safe and effective.

• Staff had undergone training in a wide range of areas. Including safeguarding, equality and diversity, fire safety, infection control and basic life support.

• The practice had supplied a copy of their training records, to demonstrate the steps taken to improve the previous training issues found.

• Systems were now in place to monitor training.

• Steps had been taken to improve the outcomes for patients with learning disabilities, patients experiencing poor mental health, and patients at risk of unplanned admission.

• Action had been taken to encourage carers to register as such to enable them to access the support available via the practice and external agencies.

The areas where the provider should make improvements are:

• Continue to ensure all registration details are up to date on the Care Quality Commission database.

• Ensure all members of staff complete health and safety training, and address any gaps in training staff may have.

Following this desk based inspection we have rated the practice as good for providing safe services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 7 April 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice