Letter from the Chief Inspector of General Practice

This inspection was an announced focused inspection carried out on 20 April 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 18 August 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:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The practice had fully reviewed the system they had in place in relation to the monitoring of the cold chain.

  Vaccine refrigerators temperatures were now checked and reset daily as per the practice policy

• The practice had reviewed the medicines kept in place in the event of an emergency. For example, anaphylaxis and updated the practice policy to reflect this.

• Issues identified in regard to infection prevention and control. For example, spillage kits for bodily fluids and the purchase of cytotoxic sharps bins had been completed.

• Patient Group Directives for travel vaccinations were now in place.

• The practice now had an effective governance system in place.

• Dispensary competencies had been reviewed and a process was in place to document any issues where appropriate.

• Appropriate policies and guidance were in place to enable staff to carry out their roles in a safe and effective manner which were reflective of the requirements of the practice.

The practice should make improvements:-

• Ensure significant events have enough clinical detail documented to demonstrate appropriate details and information are in place.

• Dispensary visit reports need to have near misses documented and discussed as detailed in the practice policy.

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 Stackyard Surgery on 18 August 2016. Overall the practice is rated as requires improvement.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, significant events and maintenance of the cold chain.

• 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.
• 93% of patients who completed the July 2016 national patient survey said they would recommend this GP practice to someone who had just moved to the local area compared to the CCG average of 78% and the national average of 75%). 99% of patients said they found the receptionists at the practice helpful compared to the CCG average of 60% and the national average of 59%)
• 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 areas where the provider must make improvements are:

• Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include arrangements for recording, analysing and acting upon significant events.

• Ensure vaccine refrigerators are checked and reset daily as per the practice policy.

• Ensure the relevant medicines are kept in place in the event of an emergency. For example, anaphylaxis.

• Address issues in regard to infection prevention and control. For example, spillage kits for bodily fluids and the purchase of cytotoxic sharps bins.

• Put in place Patient Group Directives for travel vaccinations.

In addition the provider should:

• Embed the new system for policies and procedures to ensure they are updated. For example, spillage of bodily fluids, referrals, reviewing and actioning of incoming post.

• Ensure discussions with staff in relation to any concerns are documented and kept within the member of staffs personnel file.
• Ensure that when staff had been identified as requiring further reviews and assessments of competence from their appraisal this takes place and is documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice