Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Springfield Primary Care Centre on 14 September 2016. The overall rating for the practice was requires improvement. Breaches of legal requirements were found relating to the Safe and Responsive domains. The provider did not have an effective system or process to make sure they assessed and monitored the service provided. For example, there was not an effective system in place for managing safety alerts. There was no second thermometer for all vaccine and medicine fridges in the practice. Also the practice did not ensure that persons employed by them received such appropriate support, training, professional development, supervision and appraisal as was necessary to enable them to carry out the duties they were employed to perform. For example: all staff records did not have details of up-to-date mandatory training, for example basic life support. Additionally the practice was not responsive to patient access and involvement in relation to the GP Patients’ survey responses.

After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 17 (Good governance) and regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report can be found by selecting the ‘all reports’ link for Springfield Primary Care Centre on our website at www.cqc.org.uk.

This inspection was a document-based review carried out on 3 August 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 14 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:

• All staff had completed basic life support training; we saw certificates for all staff members to demonstrate this.

• The practice had purchased a second thermometer for the medicine refrigerator. We saw photographic evidence. We also saw the health care assistant checked calibration monthly.

• The chaperone policy had been reviewed in May 2017, we saw certificates for “chaperone and consent” training for all staff who undertook chaperone duties.

• The practice had reviewed its policy on obtaining references for new staff. We saw a revised policy, and a completed reference form for the one new member of staff who had been recruited since the last inspection.

• Since the initial inspection, the practice had reviewed its protocol for recording details about patients with caring responsibilities and had identified a new search to identify carers. As a result, the number of patients recorded as carers on their clinical system had increased from 4 patients (approximately 0.06%) to 161 patients (approximately 2%). We also saw evidence of how the primary care navigator (a member of staff that provides support for carers) sign posted carers.

• There was a clear system in place to identify safety alerts and action taken as a result of safety alerts. We saw a policy that had been reviewed in October 2016; we saw a comprehensive spread sheet detailing dates, alerts, recommendation and action taken if the alert impacted on patients. We also saw minutes from clinical team meetings where safety alerts were discussed.

• The practice had reviewed the GP patient results; we saw evidence that this was discussed in an all staff meeting. We saw the practice had created their own survey to identify how they could improve patient access, and we also saw an action plan as a result of the GP patient survey and the practice’s own survey.

• There was a clear system for ensuring suitable records of meeting discussions, action points and outcomes were accessible to all staff. We saw comprehensive minutes, with actions and outcomes stored on the shared drive.

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

Importantly, the provider should:

• Continue reviewing how to respond to patient access and involvement in relation to the GP Patients survey responses. Whilst GP patient survey had improved after the inspection, the most recent data demonstrated the figures had declined.

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 Springfield Primary Care Centre on 14 September 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• 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 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.
• The practice was piloting virtual clinics such as diabetic clinics and recently hypertension clinics.
• The practice was located in a deprived area so the practice set up a weekly benefits advice centre for its patients

The areas where the provider must make improvement are:

• Ensure that staff have access to regular mandatory training to be able to respond to emergencies specifically basic life support training.

• Should consider getting a second thermometer for all vaccine and medicine fridges in the practice.

The areas where the provider should make improvement are:

• Review the system in place for receiving and managing safety alerts.

• Ensure staff who carry out chaperone duties fully understand the role and update the chaperone policy.

• Consider appropriate recruitment records are kept when verbal references are obtained.

• Continue to review the process for identifying carers and support that is provided for them.

• Ensure suitable records of meeting discussions and action points are accessible to appropriate staff.

• Consider how to respond to patient access and involvement in relation to the GP Patients survey responses.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice