Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Waterhouses Medical Practice on 21 June 2016. The practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led services. We carried out a focused inspection in respect of safe care on 5 October 2016 to check that urgent action had been taken to comply with legal requirements. We undertook a further announced comprehensive inspection at Waterhouses Medical Practice on 19 April 2017. The overall rating for the practice was good with requires improvement in providing safe services. The reports for the three inspections can be found by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 2017. It was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in the regulation that we identified in our previous inspection on 19 April 2017. 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:

• Joint injections were carried out in clinical rooms with appropriate flooring to prevent and control the risk of infection.

• Syringes, dressings and dressing packs were in date and a system for checking them had been put in place.

• Medicines used in the treatment of joint injections were stored securely.

• Prescription stationary used in printers was stored securely.

• Satisfactory evidence of conduct in previous employment was documented for locum staff who worked at the practice.

• The safeguarding policy for vulnerable adults had been updated to reflect categories or definitions of the types of abuse for example, modern slavery.

• Systems to follow up children who failed to attend for hospital appointments had been implemented.

• Alerts had been added to the records of the parents of children with a child protection plan in place.

• A formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice had been implemented. The practice had reviewed their processes for supporting nursing staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Waterhouses Medical Practice on 21 June 2016. The practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led services.

We carried out a focused inspection in respect of safe care and treatment on 5 October 2016 to check that action had been taken to comply with legal requirements. The two inspection reports can be found by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

We undertook a further announced comprehensive inspection of Waterhouses Medical Practice on 19 April 2017 to check that action had been taken to comply with legal requirements relating to providing effective and well led services. The two GP partners were not available on the day of the inspection but we spoke with a locum GP who will become a partner at the practice in November 2017. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and there had been significant improvements in reporting and recording significant events.
• The practice had clearly defined systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey published in July 2016 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. There had been a significant improvement in the recording and analysis of trends in complaints. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day especially for children, frail older patients and patients identified with complex health issues.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had significantly reduced the annual number of patients that attended A&E during GP opening hours from 115 patients per 1000 to 71 per 1000.
• There was a clear leadership structure and most staff felt supported by the management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Carry out joint injections in a clinical room with appropriate flooring to prevent and control the risk of infection.

• Implement systems to ensure items such as syringes, dressings and dressing packs are in date.

• Ensure that medicines used in the treatment of joint injections and prescriptions used in printers are stored securely.

• Ensure satisfactory evidence of conduct in previous employment is documented for all locum staff who work at the practice.

The areas where the provider should make improvement are:

• Update the safeguarding policy for vulnerable adults to reflect updated categories or definitions of the types of abuse for example, modern slavery.

• Implement systems to follow up children who failed to attend for hospital appointments.

• Add alerts to the records of the parents of children with a child protection plan in place.

• Implement a formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice. Continue to explore and implement ways in which practice nurses are supported to carry out their role.

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 of Waterhouses Medical Practice on 21 June 2016. Three breaches of legal requirement were found. A warning notice was served for:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment.

Requirement notices were served for :

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance.

• Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staffing.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

We undertook a focused follow up inspection on 5 October 2016 to check that the practice had taken urgent action to ensure they met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. This report only covers our findings in relation to the warning notice. A follow up inspection will be carried out within six months to check that the practice had followed their action plan for the two requirement notices and to confirm they meet legal requirements.

Our key findings were as follows:

• There was a formal system in place to log, review, discuss and act on alerts, such as the Medicines and Healthcare products Regulatory Agency (MHRA) alerts, received into the practice.
• Opportunities to raise significant events were identified. There was an effective system in place for reporting and recording significant events.
• Effective systems had been put in place to mitigate risks to patients who took high risk medicines.
• There was a system in place to track prescriptions throughout the practice.
• An infection control audit had been completed and an action plan had been put in place to mitigate risks identified.
• Risks identified in the practice’s legionella risk assessment and fire risk assessment had been mitigated.
• Hepatitis B immunisation records were available for most staff. Risk assessments were in place for two locum GPs whilst their hepatitis B status was confirmed.
• Emergency medicines were stored securely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Waterhouses Medical Practice on 21 June 2016. The practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led services. We carried out a focused inspection in respect of safe care on 5 October 2016 to check that urgent action had been taken to comply with legal requirements. We undertook a further announced comprehensive inspection at Waterhouses Medical Practice on 19 April 2017. The overall rating for the practice was good with requires improvement in providing safe services. The reports for the three inspections can be found by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 2017. It was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in the regulation that we identified in our previous inspection on 19 April 2017. 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:

• Joint injections were carried out in clinical rooms with appropriate flooring to prevent and control the risk of infection.

• Syringes, dressings and dressing packs were in date and a system for checking them had been put in place.

• Medicines used in the treatment of joint injections were stored securely.

• Prescription stationary used in printers was stored securely.

• Satisfactory evidence of conduct in previous employment was documented for locum staff who worked at the practice.

• The safeguarding policy for vulnerable adults had been updated to reflect categories or definitions of the types of abuse for example, modern slavery.

• Systems to follow up children who failed to attend for hospital appointments had been implemented.

• Alerts had been added to the records of the parents of children with a child protection plan in place.

• A formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice had been implemented. The practice had reviewed their processes for supporting nursing staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice