Letter from the Chief Inspector of General Practice

We had previously carried out an announced comprehensive inspection at this practice on 28 September 2016 and found breaches of regulation and rated the practice as ‘Requires improvement’ in the safe and well-led key question. The practice was rated as ‘Requires improvement’ overall. The full comprehensive report on the 29 September inspection can be found by selecting the ‘all reports’ link for The Uppingham Surgery on our website at www.cqc.org.uk.

Specifically we found that;

• The practice did not have a clear or consistent system for reporting, recording and monitoring significant events, incidents and accidents.

• The systems and process to address the risks associated with fire and legionella were not implemented well enough to help ensure people were kept safe.

• There was no clear process in place to alert health care professionals that patients were being prescribed disease modifying drugs in secondary care.

• The provider had not have systems in place to ensure that staff were properly recruited.

• The practice had a governance framework in place which supported the delivery of the strategy and quality care. However, we found the systems and processes in place with regard to significant events, monitoring of risk and staff recruitment were not effective

This inspection was an announced focused inspection carried out on 9 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 29 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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The practice is now rated as ‘Good’ in the safe and well-led key questions and ‘Good’ overall.

Our key findings were as follows:

• There were systems for recording, monitoring, acting, reviewing and learning from significant events.

• There were systems to assess and monitor the potential risk from fire and legionella.

• Systems had been improved to help ensure that patient notes were summarised in a timely manner.

• There was a clear process in place for the management of disease modifying drugs prescribed for patients in secondary care.

• Staff were recruited only after the necessary checks had been made.

In addition we found that:

• Blank prescription pads were managed in line with national guidance.

• Random spot checking of the cleaning efficacy at all four surgeries had been introduced.

• Meeting agenda across all staff groups were formalised and discussions recorded.

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 Uppingham Surgery on 29 September 2016. Overall the practice is rated as requires improvement.

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

• The practice did not have a clear or consistent system in place for reporting, recording and monitoring significant events, incidents and accidents.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were shared to ensure action was taken to improve safety. However, the practice did not review significant events for themes and trends to maximise learning and mitigate further errors.

• Risks to patients were assessed but these were not always well managed.

• Where medicines were being prescribed by secondary care we saw evidence that the health care professionals in the practice were not always alerted to this
• 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.
• Comments cards we reviewed told us patients felt they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• 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:

• Review the system for recording, acting on and monitoring significant events, incidents and near misses to include patient impact and outcome, discussion and audit trail.
• Review themes and trends from significant events and complaints to ensure actions are taken in a timely manner.
• Improve governance arrangements systems for assessing and monitoring risks and ensure identified actions are addressed. For example, fire, legionella, summarisation of patient notes.

• Review the system for safety alerts and ensure they are actioned in a timely manner and discussed at clinical meetings.

• Continue to embed a proper and safe system for the management of medicines. For example, medicines prescribed by secondary care.

• Ensure recruitment arrangements include all necessary employment checks for all staff and are in line with Section 3 of the Health and Social Care Act 2008.

In addition the provider should:

• Complete an Infection control action plan to ensure all actions are completed and document cleaning spot checks carried out on a regular basis.

• Ensure blank prescriptions pads and printer stationary are handled in accordance with national guidance.

• Formalise meeting agendas and minutes to ensure they are easy to follow and key areas are discussed on a regular basis and well documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice