Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stag Medical Centre on 25 April 2016. The overall rating for the practice was Good but with Requires Improvement for safety. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Stag Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 June 2017 to confirm that the practice had taken action to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 25 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

The practice had taken action to meet the legal requirements. Our key findings were as follows:

• The practice had improved systems to manage health and safety. Health and safety risk assessments for the premises including a fire risk assessment had been completed. Fire drills had been completed and work had been completed to ensure blinds in the practice met Department of Health guidance.

• Checks of the defibrillator had been undertaken to meet relevant guidance.

• Systems had been improved to ensure blank prescription forms and pads were securely stored in line with relevant guidance.

• Systems to improve the management of infection, prevention and control (IPC) had been improved including records of the cleaning had been implemented and completed and staff had received IPC training. Annual IPC audits to monitor standards had been undertaken.

The practice had also taken action in areas recommended for improvement:

• Systems had been implemented to review actions taken in response to significant events to check these had been implemented appropriately and had been effective.

• Procedures for recording the actions taken in response to medical alerts had been improved and implemented.

• Training had been provided for staff who were undertaking chaperone duties.

• Arrangements for monitoring the temperature of the vaccine fridge in relation to the provision of thermometers had been reviewed and improved in line with relevant guidance.

• Procedures for obtaining written consent from patients prior to minor surgical procedures and contraceptive implants had been reviewed. New consent forms had been developed and implemented.The practice had also introduced a World Health Organisation (WHO) check list for surgical procedures to assist clinicians to ensure all the appropriate records were completed and information had been provided to the patient. Completed documents were stored on the patient record.

• Access to the practice by telephone and to a named GP had been reviewed. Since the last inspection the practice had commenced the Productive General Practice programme. (Productive General Practice is a programme from the NHS Institute which aims to support general practices in realising internal efficiencies, while maintaining quality of care and releasing time to spend on more value added activities.) The practice had used this system to review their appointment system. An audit had showed 93% of appointments were given to patients as per the patients request. The data had enabled the practice to review staffing requirements and in response to the information provided had employed an advanced nurse practitioner to improve access to appointments. The practice had also had a new telephone system in November 2016 which provided more lines and a call waiting system. This system enabled the practice to monitor call waiting times and discontinued calls. The practice was in the process of reviewing the data from this information to identify if any further improvements could be made.

• Information about the complaints procedure was displayed in the practice to ensure access for patients.

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

• Secure the clinical waste bins stored in the car park so they cannot be moved by the general public.

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 Stag Medical Centre on 25 April 2016. Overall the practice is rated as good.

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

• There was an effective system in place for reporting and recording significant events although they had not reviewed actions taken in response to significant events to ensure these were effective.
• Lessons were shared to make sure action was taken to improve safety in the practice although they had not recorded actions taken in response to medical alerts.
• When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Staff had not received chaperone training where they carried out this role.

• Not all risks to patients were assessed. Areas relating to fire safety and infection prevention and control required improvement.
• 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, staff had not received infection control training.
• 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.
• Although the practice had made changes to improve the appointment system patients said they did not find it easy to make an appointment with a named GP and they struggled to get through to the practice by telephone. Urgent appointments were 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.

We saw one area of outstanding practice:

The PPG was active in the practice and involved in the development of the practice and services for those in the local community. They had 14 members who met monthly and a virtual group with 60 members. They communicated with patients through a bi-monthly newsletter and a social media page. The PPG members also assisted the practice at the annual flu clinics and used this opportunity to fund raise for local charities and promote the practice PPG.

They had developed and arranged a weekly carers café where they could offer support for patients who were carers.

The PPG members were working with a representative of the local Rotary Club to raise the profile of Admiral Nurses to enable a better service for patients and families living with dementia in the practice and the Rotherham area. They were also visiting local businesses to encourage them to become dementia friendly organisations.

The practice PPG had won the Corkhill Award in 2014 as presented by the National Association of Patient Participation (NAPP). This is an annual award for the PPG considered to be the best in providing all the elements of a successful PPG.

The PPG had also initiated the Rotherham PPG Network in conjunction with the Rotherham CCG and supported and encouraged other PPGs to take on board best practice in the formation and running of a successful PPG. They had also worked with organisations such as NAPP and NHS England on projects to raise the quality standards for PPGs.

The areas where the provider must make improvement are:

• Review infection control procedures and implement The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance. Ensure all staff are trained in infection prevention and control (IPC) and regularly monitor the standards of IPC in the practice. Maintain a record of cleaning and ensure all areas of the practice are clean.
• Review procedures relating to the security of blank prescription forms and pads to ensure these are stored in line with NHS Protect, Security of prescription forms guidance, updated August 2013.
• Ensure the health and safety of patients and others entering the building is risk assessed and actions to mitigate any identified risk are implemented and monitored. Ensure fire risks are assessed. Ensure staff have knowledge of and have the opportunity to practice the procedures to be taken in the event of a fire at Rosecourt surgery. Implement the Department of Health guidance February 2015 relating to blinds and blind cords to minimise the risk of serious injury due to entanglement.

• Review procedures for checking the emergency equipment is in working order. Ensure a reliable system of emergency equipment checks and replacement in line with the Resuscitation Council (UK) guidance is implemented.

The areas where the provider should make improvement are:

• Review actions taken in response to significant events periodically to check these have been implemented appropriately and have been effective.
• Review procedures for recording actions have been taken in response to medical alerts.

• Put procedures in place to so staff who undertake chaperone duties are trained for this role and staff records reflect this.

• Review arrangements for monitoring the temperature of the vaccine fridge in relation to the provision of thermometers in line with the Public Health England (PHE): Protocol for ordering, storing and handling vaccines, March 2014.
• Consider implementation of written consent for patients prior to minor surgical procedures and contraceptive implants.
• Review and improve access to the practice by telephone and to a named GP.
• Provide patients easy access to information about the complaints procedure in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice