Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lyndhurst Surgery on 29 October 2014. The overall rating for the practice was requires improvement. The full comprehensive report published in May 2015 can be found by selecting the ‘all reports’ link for The Lyndhurst Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 March 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 29 October 2014. There were breaches in medicines management procedures including the repeat prescribing process and also in recruitment processes. There were also concerns with the management and leadership in the practice, particularly with the training of staff members, risk assessments including fire safety and legionella testing, the safety of electrical equipment and procedures for dealing with medical emergencies. 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:

• The practice used a system to ensure vaccines were safely stored and managed, including an effective cold chain policy and a system for ensuring all vaccines were in date.

• All emergency medicines and disposable equipment were in date and there was a system to monitor their use.

• Risks to patients were well assessed, there was a fire risk assessment, all staff had fire safety training appropriate to their role and regular fire drills were carried out and learning was shared.

• There was an up to date infection control audit and a legionella risk assessment and the practice had carried out the actions identified as a result.

• All staff had completed mandatory training including chaperone training and equality and diversity training and had access to an online training portal where they were able to complete training other than mandatory training that they had an interest in.

• There was an effective medicines management system, which included a policy, staff were aware of their roles and remits, only GPs issued prescriptions for controlled and high risk medicine or for medicines when the patient review was overdue.

• Electrical equipment had been tested to ensure it was safe to use and clinical equipment had been calibrated to ensure it was safe, in good working order and fit for purpose.

• The practice had a risk assessment to mitigate against the risks of not having a defibrillator and a signed guidance sheet for summoning appropriate help in the event of a medical emergency or cardiac arrest, however the practice purchased a defibrillator by the end of the inspection.

• The practice carried out regular meetings which all staff were expected to attend, there were standing agenda items, which included significant events, complaints and any other business. Regular clinical meetings were also held and copies of the minutes were provided to the practice nurse when they could not attend, the practice nurse also attended the local nurse’s form.

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 Lyndhurst Surgery on 29 October 2014. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and well led services. It also required improvement for providing services for older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

It was good for providing an effective, caring and responsive service.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• 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.
• Urgent appointments were usually available on the day they were requested.

The areas where the provider must make improvements are:

• Ensure safe systems are in place for the management of medicines. Repeat prescriptions to be reviewed and passed on to GPs to review where medication reviews are due.
• Ensure recruitment arrangements include all the necessary employment checks for all staff, including staff who acted as chaperones.

In addition the provider should:

• Provide training for staff to ensure they are equipped with the knowledge and skills to effectively perform their job role. This includes training in chaperoning patients, equality and diversity and fire training.
• Ensure a Legionella risk assessment is completed to reduce the risk of infection to staff and patients.
• Ensure portable electrical equipment is routinely tested.
• Put in place procedures for dealing with emergencies including the action to take in the absence of a defibrillator.
• Ensure a fire risk assessment is completed to maintain fire safety.
• Improve opportunities for interaction between the two practice nurses and wider clinical team, to ensure they do not work in isolation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice