We carried out an announced comprehensive inspection at The James Cochrane Practice on 15 September 2016. The overall rating for the practice was good, but requires improvement for providing safe services.

We carried out an announced focused inspection at the practice on 23 May 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 15 September 2016. The practice was rated as good overall, however, were rated requires improvement for providing safe services. Some of the issues raised at the inspection of September 2016 had not been addressed and there were further areas of concern. The reports on the September 2016 and May 2017 inspections can be found by selecting the ‘all reports’ link for The James Cochrane Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 March 2018 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 23 May 2017. This report covers our findings in relation to those requirements.

The practice is still rated as good overall and now good for providing safe services. We saw that improvements had been made.

Our key findings were as follows:

• The practice had improved the arrangements for medicines management since the last inspection.

We also found:

• The number of patients registered at the practice had increased from approximately 16580 to 17500.
• The practice had changed the staff structure at the practice to improve accountability and had employed a different skill mix of staff, for example a senior clinical pharmacist.

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 The James Cochrane Practice on 15 September 2016. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for The James Cochrane Practice on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 23 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 15 September 2016. This report covers our findings in relation to those requirements.

Overall the practice is rated as good, however the practice remains rated as requires improvement for safety. The practice had not addressed all issues raised at the last inspection, and we found further areas of concern.

Our key findings were as follows:

• Although some improvements had been made to management systems, the arrangements for checking temperatures in medicine refrigerators, uncollected prescriptions, the management of controlled stationery, including prescriptions, and the signing of Patient Group Directions by a prescriber were not in accord with expected standards and did not minimise the associated risks.
• There were standard operating procedures in place in relation to medicines management.
• The practice had risk assessed their dispensing procedures and taken the decision to close the dispensary at the Maude Street surgery.
• Appropriate arrangements were now in place for checking emergency medicines and equipment, controlled drugs, and the expiry dates of medicines.
• Action had been taken to ensure patients who were due a medication review were seen.

There were areas of practice where the provider must make improvements:

• Ensure that the procedures put in place to monitor medicine refrigerator temperatures and uncollected prescriptions are adhered to.
• Ensure that Patient Group Directions are signed by an appropriate prescriber.
• Ensure the process for managing controlled stationary at the practice includes tracking the use of handwritten prescription pads at Helme Chase, and recording blank computer prescriptions which are transferred between Helme Chase and Maude Street.

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 The James Cochrane Practice on 15 September 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.

• Some risks to patients were assessed and well managed.

• The arrangements for managing medicines, including emergency drugs and vaccinations, in the practice did not keep patients safe.

• Outcomes for patients who use services were good.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.

• Patients said they were able to get an appointment with a GP when they needed one, 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 leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.

• Staff throughout the practice worked well together as a team.

• The practice was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had led a care home project for the elderly. The aim was to provide high quality care for patients in order to reduce the likelihood of acute admission to hospital. It also aimed to ensure that patients’ end of life plans were in place so that their preferences about their place of death could be met. The practice reported that almost all (92%) patients died in accordance with their known preferences.

The areas where the provider must make improvements are:

• The practice must assure the appropriate and safe storage of medicines and more effective management of repeat prescriptions for patients.

The areas where the provider should make improvements are:

• Consider Disclosure and Barring Service (DBS) checks for staff who carry out chaperoning duties, and carry out risk assessments for administration staff who have not received a DBS check.

• Consider carrying out a yearly fire evacuation drill.

• Review the system in place for the checking and reading of hospital discharge letters, and letters from out of hours services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice