Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whitchurch Surgery on 10 August 2016. The practice was rated good for effective, caring, responsive and well-led, and was rated requires improvement for safe. The overall rating for the practice was good. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Whitchurch Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 April 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 10 August 2016. This report covers our findings in relation to those requirements.

At our previous inspection on 10 August 2016, we rated the practice as requires improvement for providing safe services as the practice was not operating an adequate system with regards to water safety; there was no system in place to track blank prescription forms and pads and monitor their use; not all staff had up to date training with regards to infection control and prevention. 

It was also noted on the previous inspection that the practice should ensure that dispensary staff had the correct qualifications and that there were embedded systems in place for monitoring the dispensing process. It was noted that there was no designated sink for use in the dispensary for the hygienic preparation of medicines, cleaning and hand washing and no standard operating procedures in place to reflect current good practice in the dispensary processes. The practice was also asked to consider how to ensure greater privacy for patients at the reception area and consider how to improve patient outcomes for those with long term conditions.  

Our key findings for 12 April 2017

• We found that there were processes in place for ensuring water safety at the practice.

• The practice had systems in place to track prescription storage and usage.

• All staff had received up to date and formal training with regards to infection control and prevention.

• Steps were being taken to remedy the problems with privacy for patients at the reception area with some work already undertaken to reduce the risk of being overheard.

• The dispensary had fully qualified and experienced staff and was evidenced to have quality processes in place to maintain and improve the dispensary processes.

• Patients with long term conditions now have more support with a dedicated lead GP for each type or group of conditions and a lead nurse has undertaken an extensive review programme.  A revised recall system was introduced that operated more on patient need.

   

  The practice is now rated as good for providing safe services.

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 Whitchurch Surgery on 10th August 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events.
• 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to make a routine appointment with a GP 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 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 practice adopted a model whereby one GP and an advanced nurse practitioner constituted a ‘pod’. This structure enabled communication among clinicians to address patients’ health more comprehensively, better ensure the continuity of care and team working. There was also protected time for discussions twice a day for the GPs and the advanced nurse practitioners (pods) following their clinics which provided opportunity for support and shared learning.

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

• Ensure a system is in place to track blank prescription forms and pads, and monitor their use.
• The practice must operate a system to respond to the control measures as outlined in their protocol and as identified from a previous risk assessment in respect of the risks from exposure to Legionella in man-made water systems. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
• The practice must provide formal training to all staff, relevant to their roles, for example infection prevention and control prevention and awareness.

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

• Review the qualifications and continued professional development of the dispensary staff.
• Ensure systems are embedded to monitor the quality of the dispensing process
• Review the availability of a designated sink for use in the dispensary for the hygienic preparation of medicines, cleaning and hand washing.
• The practice should review its standard operating procedures regarding the dispensing processes in order to reflect current good practice.
• The practice should take steps to ensure patient’s privacy at the reception area.
• The practice should continue to improve patient outcomes for those with long term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection with spoke with six people who used the service. Everyone we spoke with told us that overall they were satisfied with the service they received and had confidence in the abilities of the GPs. One patient told us “everyone here is wonderful, so friendly and helpful”. Another patient told us “I’m very happy with the services, it’s very easy to get an appointment on the same day or the day after if you don’t mind which doctor you see”.

We found the consulting rooms, waiting area and toilets were clean and tidy and free from odours. Patients we spoke with said they had no concerns about hygiene standards within the practice.

Patients were cared for, or supported by suitably qualified, skilled and experienced staff. Records we reviewed showed there were effective recruitment and selection processes in place.

Patients who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse from happening.

The practice sought the views of patients and acted upon the feedback received. There was a Patient Participation Group who supported the practice to monitor their performance. The practice undertook periodical clinical and nonclinical audits throughout the year.