Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Robins Surgery on 8 May 2017. Overall the practice is rated as requires improvement.

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

• There was no written policy for significant events. Not all staff understood their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks but these related to staff recruited prior to registration with the Care Quality Commission.
• Not all staff had received mandatory training. For example in safeguarding, fire safety, information governance and chaperoning.
• Data showed patient outcomes were low compared to the national average in some aspects, for example diabetes, but similar to the national average in respect of others.
• Audits had been carried out and results were used to drive improvements to patient outcomes.

• Results from the national GP patient survey showed patients views were mixed about whether they felt they were treated with compassion, dignity and respect. Their views were also mixed about their involvement in planning and making decisions about their care and treatment.

• The practice had a number of policies and procedures to govern activity with the exception of a policy for significant events.

• No evidence or examples of feedback were available of where staff feedback had been acted upon.

The areas where the provider must make improvements are:

• Ensure all staff understand their responsibilities in relation to significant events and that such events are reviewed regularly to identify and address and trends.

• Assess, monitor and mitigate the risks relating to the health, safety and welfare of patients specifically in relation to significant events, staff training, safeguarding, prescription form security and maintenance of emergency equipment.
• Ensure processes and procedures are in place to support the seeking and acting on of feedback from patients for the purposes of continually evaluating and improving such services. For example through a patient participation group (PPG) in place and responses to the friends and families test.

In addition the provider should:

• Consider how to assist patients with a hearing impairment accessing the service.

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 Robins Surgery on 26 November 2015. Overall the practice is rated as requires improvement.

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.
• Risks to patients who used services were not always assessed, and the systems and processes to address risks were not always implemented well enough to ensure patients were kept safe. For example premises cleaning audits, recruitment checks including staff identity checks, and Disclosure and Barring Service (DBS) risk asessments for chaperones had not been carried out. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• The prescribing policy did not ensure safe management of medicines.
• Data showed patient outcomes were comparable to the locality and nationally. Although some audits had been carried out, we saw little evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients comments cards and the majority of patients we spoke to said they were treated with compassion, dignity and respect.
• Information about services was available but not everyone would be able to access it, for example translation services were not advertised in the reception area.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, but some important ones were missing for example the health and safety policy.
• The practice had proactively sought feedback from patients online and had an active patient participation group.
• There was an effective system in place for reporting and recording significant events.
• Not all staff had received mandatory annual basic life support and safeguarding training.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Ensure protocols for repeat prescribing of medicines and the monitoring of repeat prescriptions are clear, safe and aligned to national prescribing guidance and GMC and NMC best practice guidelines.
• Ensure recruitment arrangements include all necessary pre-employment checks for all staff.
• Ensure all staff receive mandatory annual Basic Life Support (BLS) training, infection control training, chaperoning, and child and adult safeguarding training as appropriate to their role.
• Ensure that all chaperones are risk assessed for a DBS check.
• Ensure a health and safety policy and related audits and risk assessments are in place, for example for shortages of staff, the building and COSHH (Control of Substances Hazardous to Health) risk assessments and associated safety guidance.

In addition the provider should:

• Follow up on staff concerns in relation to standards of premises and privacy curtains cleaning.
• Ensure all staff read and are fully aware of policies and procedures relevant to their role, for example the whistleblowing policy.
• Ensure all staff are aware of the practices forward vision and put associated information in the reception area for patients reference.
• Record patients consent for intimate investigations and minor surgery.
• Ensure all disposable medical equipment is within the expiry date.
• Arrange whole team staff meetings and consider regular one to one meetings for all staff.
• Improve patients privacy at the reception desk to minimise the risk of conversations being overheard.
• Advertise translation services and the availability of a private room in the reception area so that patients know these facilities are available.

Professor Steve Field CBE FRCP FFPH FRCGP

​Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection May 2017 – Requires improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Robins Surgery on 2 May 2018, to follow up on breaches of regulations identified at our inspection in May 2017. At our previous inspection in May 2017, we rated the practice requires improvement for providing safe, effective, caring and well-led services, and good for responsive services. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for The Robins Surgery on our website at www.cqc.org.uk.

At this inspection we found:

The practice had addressed all concerns that were identified at our previous inspections.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Staff had received the necessary training to carry out their work effectively.
• The management and staff had engaged with patients and responded positively to their feedback.
• The new computer software enabled the practice staff to review the effectiveness and appropriateness of the care it provided.
• Staff delivered patient care and treatment according to evidence- based guidelines.
• Staff treated patients with compassion, kindness, dignity and respect.
• Patients reported that they were able to access care when they needed it.
• There was a focus on improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review patients on high-risk medicines to ensure shared care agreements are put into place.
• Review the recruitment, serious events, and business continuity policies to ensure they include the necessary information.
• Review the needs of carers to identify how staff could provide further support.
• Review the prioritising of appointments and implement a standard operating procedure to reflect this.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice