Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bevan and partners on 18 May 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 generally assessed and well managed, with the exception of the dispensary, where management of medicines required improvement.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment, although the dispensary staff required update training and there were gaps in infection control training for non-clinical staff. Non-clinical staff appraisals had not been completed for over 18 months.
• 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 and there was availability of urgent appointments available the same day via the triage system.
• 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:

• Ensure appropriate systems are in place for the proper and safe management of medicines including dispensing, audit, recording and destruction of controlled drugs and followed correctly and that standard operating procedures contain all the relevant information.

The areas where the provider should make improvement are:

• Ensure staff receive appropriate training and appraisals; update training for dispensary staff in dispensary procedures including management of controlled drugs and update training in infection control and infection control audit.
• Continue to identify and support carers.
• Advise patients at the branch surgery what to do when the dispensary is closed.
• Implement a system to provide an audit trail for blank prescriptions at the branch practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

When we inspected the practice, in December 2013, we noted that improvements were required in relation to infection control and cleaning. We judged that this had a minor impact on people using the service and required the practice to make improvements.

Following our visit the practice sent us an action plan, which identified the work to be undertaken to meet the essential standards. We visited the practice again, in July 2014, to check that the required work had been completed.

We found that the practice had reviewed all cleaning arrangements and had new contracts in place with external cleaning companies. The practice manager received regular reports and audits of the standard of cleaning across the practice.

We found that improvements had been made and maintained to meet the essential standards.

We spoke with seven patients about their experiences within the practice and most patients identified positive outcomes. One patient said, “This is a good practice. I have no complaints.” Another patient said, “The reception staff are very friendly, and other staff are good too.” Another patient indicated that the appointments to see their chosen GP regularly ran late, though this was the only person to voice that concern.

We noted that there were improvements required to the infection control and cleaning of both practice locations.

We met with the Patient Participation Group (PPG) and they shared with us their plans for involvement with the practice staff.

We saw the appropriate recruitment checks were undertaken before staff began work.

We visited both locations which were purpose built environments.

We found patients felt confident to raise concerns but all those we spoke with said they had nothing to complain about, or declined to make a formal complaint. Patients said if they did have a complaint, they would first speak with the receptionist or the doctor.

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of Dr Bevan and Partners on 28 March 2017. This was to check that improvements had been made following the breach of legal requirements we identified from our comprehensive inspection carried out on 18 May 2016. During our inspection in May 2016 we identified a regulatory breach in relation to:

• Regulation 12 HSCA (RA) Regulations 2014 safe care and treatment

This report only covers our findings in relation to the areas identified as requiring improvement following our inspection in May 2016. You can read the report from this comprehensive inspection, by selecting the 'all reports' link for Dr Bevan and Partners on our website at www.cqc.org.uk. The areas identified as requiring improvement during our inspection in May 2016 were as follows:

• Ensure appropriate systems are in place for the proper and safe management of medicines including dispensing, audit, recording and destruction of controlled drugs and followed correctly and that standard operating procedures contain all the relevant information.

In addition, the practice were told they should:

• Ensure staff receive appropriate training and appraisals; update training for dispensary staff in dispensary procedures including management of controlled drugs and update training in infection control and infection control audit.
• Continue to identify and support carers.
• Advise patients at the branch surgery what to do when the dispensary is closed.
• Implement a system to provide an audit trail for blank prescriptions at the branch practice.

Our focused review on 28 March 2017 showed that improvements had been made and our key findings across the areas we inspected were as follows:

• The practice had arranged a training session for dispensary staff in managing controlled drugs (medicines that require extra checks and special storage because of their potential for misuse) and they had put procedures in place to manage them safely. One member of staff had not yet qualified as a dispenser, and was fully supervised when dispensing controlled drugs.
• The controlled drugs policy had been revised to include details of the NHS England Controlled Drugs Accountable Officer.
• Controlled drugs were stored in a controlled drugs cupboard, access to them was restricted and the keys held securely.
• There were arrangements in place for the destruction of controlled drugs, and the out of date stock we saw at our last inspection had been disposed of in the presence of an authorised witness. Records were kept in line with controlled drugs legislation.
• We saw records of regular checks on controlled drugs stock, and a three monthly report was made to the practice clinical meeting. During one of the routine checks, staff had identified a discrepancy which had been appropriately recorded, reported and investigated. The controlled drugs procedure had been revised to reduce the risk of this type of error happening again.
• Blank prescriptions at the branch surgery were stored securely and the practice had introduced a log of serial numbers to monitor their use in line with national guidance.
• In the afternoons when the dispensary was closed, prescriptions and dispensed medicines could be collected by arrangement at the main surgery in Irthlingborough, or the prescription could be sent to a community pharmacy to be dispensed. The practice had taken to steps to ensure patients were aware of who to contact when the dispensary was closed.
• The practice held a register of patients identified as carers and promoted support services available to carers and including information in patients areas in order to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice