- GP practice
Archived: Spring Farm Surgery
Important:
The provider of this service changed. See new profile
Important:
The provider of this service changed - see old profile
All Inspections
5 March 2019 to 5 March 2019
During a routine inspection
We carried out an announced comprehensive inspection at Spring Farm Surgery on 5 March 2019 as part of our inspection programme.
At the last inspection in April 2018 we rated the practice as requires improvement for providing safe services because:
- The overview of staff training did not include role specific training for staff members.
- The systems in place to ensure security of prescriptions and the collection of prescriptions by patients required further work to ensure they were fully effective.
- The practice did not have an effective system in place to ensure it adhered to the recommended guidance in the 'Green Book' Immunisation Against Infectious Diseases, which provided information on immunisation for employees in general practice.
At this inspection, we found that the provider had satisfactorily addressed these areas.
We based our judgement of the quality of care at this service on a combination of:
- What we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as good overall and good for all population groups.
We found:
- The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.
- There were adequate in systems to assess, monitor and manage risks to patient safety.
- The practice learned and made improvements when things went wrong.
- Staff had the information they needed to deliver safe care and treatment to patients.
- The practice had systems to keep clinicians up to date with current evidence-based practice.
- Staff had the skills, knowledge, and experience to carry out their roles.
- The provider was supported by a effective management team.
Whilst we found no breaches of regulations, the provider should:
- Review the workflow management protocol to ensure that all the clinical and non-clinical staff follow a consistent approach in regards to the scanning of patient documents.
- Review the management of the advanced nurse practitioner to ensure there is a system in place to review their medical prescribing.
- Review the significant event register to ensure it has clearer descriptions of the issues and the learning.
- Review the practice opening times to ensure they are meeting patient needs.
- Review and improve the relationship with the patient participation group.
- Review clinical audits to ensure that show improvements over two cycles.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP Chief Inspector of Primary Medical Services and Integrated Care.
4 April 2018
During a routine inspection
This practice is rated as Good overall.
Following the CQC inspection on 22 May 2017 the CQC rated the practice overall as inadequate and urgently suspended the provider’s registration for six months to enable the provider to take action to improve, whilst removing patients from the risk of harm. A caretaker practice identified by NHS England took over to provide care and treatment during this period. On 6 November 2017, CQC revisited the practice and found the provider had made sufficient improvements to allow the period of suspension to end. The CQC did not rate the practice at the November 2017 inspection.
At this inspection we rated the practice as Good overall.
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? – Requires Improvement
We carried out an announced comprehensive inspection at Spring Farm Surgery on 4 April 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm whether the practice was now meeting legal requirements.
At this inspection we found:
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The practice had made significant improvements in relation to patient safety, and effective and responsive care. However, further work needed to be carried out in response to the needs of carers, and the development and embedding of systems and processes to ensure a consistent high quality of care.
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The provider had made improvements to the premises.
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The practice had clear systems to keep people safe and safeguarded from abuse.
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There were adequate systems to assess, monitor, and manage risks to patient safety.
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The practice learned and made improvements when things went wrong.
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Staff had the information they needed to deliver safe care and treatment to patients.
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The practice had systems to keep clinicians up to date with current evidence-based practice.
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Staff had the skills, knowledge, and experience to carry out their roles.
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The practice obtained consent to care and treatment in line with legislation and guidance.
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Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
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The practice took complaints and concerns seriously and responded to them appropriately to improve patient experience and the quality of care.
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The provider acknowledged and responded to feedback from staff and patients. The practice had an active Patient Participation Group (PPG).
The areas where the provider must make improvements as they are in breach of regulations are:
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Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
- Review the annual schedule of the calibration of equipment to ensure it includes all the necessary equipment.
- Review the actions that staff take to ensure that carers needs continue to be identified and responded to.
- Review whether staff required Mental Capacity Act training.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
6 November 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Spring Farm Surgery on 22 May 2017. The overall rating for the practice was inadequate and it was placed into special measures. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Spring Farm Surgery on our website at www.cqc.org.uk. Because of the concerns found at the inspection we served the provider with a notice to impose an urgent suspension of the regulated activities from the location for a period of six months from 23 May 2017 to 24 November 2017 under Section 31 of the Health and Social Care Act 2008 (“the Act”).
This inspection was an announced focused inspection carried out on 6 November 2017 to check whether the provider had made sufficient improvements to allow the suspension to end or if further enforcement action was necessary. The practice was not rated on this occasion.
Following our focused inspection we found the provider had implemented sufficient improvements to allow the period of suspension to end.
Our key findings across all the areas we inspected were as follows:
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There were suitable health and safety risk management arrangements, recruitment checks and relevant staff training.
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There were suitable arrangements in place to respond to medical emergencies.
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A mandatory training programme had been identified for the staff team and most staff had completed most of the training identified as relevant to their roles.
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We noted a few gaps in staff training, which the provider has since inspection prepared a schedule and monitoring arrangements to address.
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There was an effective system for handling complaints and concerns.
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There were arrangements in place to seek and act on feedback from staff and patients.
Some of the changes implemented can only be assessed once they have been in use for some time – then the appropriateness, workability and sustainability of the new systems and processes can be determined.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
22 May 2017
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Spring Farm Surgery 22 May 2017.
The inspection was a comprehensive follow up of an inspection on 17 February 2016 where the practice was rated inadequate for safe, requires improvement for effective, caring and well led and good for responsive. Overall the practice was rated requires improvement. At this inspection we found breaches of legal requirements and we issued an urgent suspension of the provider's registration for a period of six months to enable the provider to take action to improve while removing patients from the risk of harm. A caretaker practice has since been identified by NHS England to provide care and treatment to patients at the practice during this period. Overall, at this inspection the practice is rated as inadequate.
The report from our last comprehensive inspection can be found by selecting the 'all reports' Spring Farm Surgery on our website at www.cqc.org.uk.
Our key findings across all the areas we inspected were as follows:
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There was no evidence of learning and communication with staff about incidents, near misses and concerns.
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Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, the practice had failed to adequately review its ability to respond effectively in the event of an emergency or mitigate any risks associated with the absence of oxygen, adequate supplies of emergency medicine and a defibrillator.
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The practice failed to mitigate the risks associated with fire. There was no testing of fire alarms or fire drills. There was no evidence that all staff had undergone fire safety training. There were no designated fire marshals within the practice.
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Electrical safety checks had not been carried out on portable equipment and no health and safety audits were carried out.
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Staff undertaking chaperone duties had not been trained to conduct this role and had limited understanding of what the role entailed.
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There was no programme of in-house training. The practice could not demonstrate how they ensured role-specific training and updating for relevant staff. For example, the practice could not demonstrate that all staff had received mandatory training such as fire safety, basic life support, infection control and information governance.
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Appropriate recruitment checks had not always been undertaken prior to employment.
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Patient outcomes were hard to identify as there was limited reference to audits or quality improvement. The audits carried out by the practice were single cycle audits meaning they had not been repeated to ensure improvements had been achieved. There was no evidence that the practice was comparing its performance to others; either locally or nationally.
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Rates of childhood immunisations were below average.
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The practice did not have a patient participation group (PPG). It did have a patient reference group (PRG) however this group was not used effectively as a source of obtaining patient views and keeping patients informed about what was going on at the practice.
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Patients were positive about their interactions with most staff and said they were treated with compassion and dignity. However patient feedback in relation to consultations with GPs was less positive.
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Patients we spoke with told us they were able to get appointments when they needed them however some patients stated on the comment cards that they had to wait too long to get an appointment.
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The practice could not demonstrate that learning from complaints was shared with all staff and that complaints were reviewed regularly to identify any trends.
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The practice had a leadership structure however we found insufficient leadership capacity and limited formal governance arrangements.
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The practice did not have a complete set of practice specific policies which were implemented and were available to all staff. For example staff were unable to show us policies about staff training, health and safety, infection control, complaints and chaperoning.
The areas where the provider must make improvements are:
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Review the system for reporting, recording and sharing learning from significant events to ensure it is effective and that it supports the recording of notifiable incidents under the duty of candour.
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Ensure sufficient quantities of equipment or medicines to ensure the safety of patients and to meet their needs. In particular, the availability of oxygen, a range of emergency medicines and a defibrillator.
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Ensure persons employed for the purposes of carrying on a regulated activity are of good character including by carrying out appropriate pre-employment checks for all staff.
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Update the business continuity plan and ensure it contains contact details for all staff and service providers.
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Ensure a continuous programme of quality improvement, including re-audits is introduced.
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Ensure learning from complaints is discussed, analysed and shared for the purposes of evaluating and improving their practice.
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Ensure effective systems and processes are in place at the practice, in particular regarding vision and strategy, governance, staffing, practice policies, performance awareness, quality improvement, risk management and leadership.
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Provide staff with appropriate support and training to carry out their duties.
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Improve processes to support the seeking and acting on of feedback from relevant persons, including a patient participation group (PPG), on the services provided for the purposes of continual evaluation and improvement.
The areas where the provider should make improvement are:
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Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
- Consider how to assist patients with a hearing impairment accessing the service.
On 23 May 2017 we took urgent enforcement action to suspend the providers of Spring Farm Surgery from providing primary medical services under Section 31 of the Health and Social Care Act 2008 ("the Act”) for a period of six months to protect patients. We will inspect the practice again prior to the end of the six month suspension. A caretaker practice has been put in place by NHS England to provide primary medical services to patients of the practice during this period.
I am also placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
17 February 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Spring Farm Surgery on 17 February 2016. 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.
- Robust systems were not in place to review the blood test results of patients on medicines such as methotrexate that require regular blood tests in accordance with NICE guidance.
- There was no defibrillator at the main practice and no risk assessment to ensure the safety of this had been carried out.
- The provider was aware of and complied with the requirements of duty of candour.
- Risks to patients were not well managed, not all staff had references in their files and there was no fire risk assessment, smoke or fire detectors, or fire drills carried out.
- Immediate actions highlighted in the infection control audit had not been carried out and there was no legionella testing. There was no evidence that cleaning schedules were being followed and we found surface dust in many areas of the practice.
- The vaccine fridge had frozen over damaging the integrity of many vaccines. Some emergency drugs were out of date as well as syringes and needles.
- There were no completed audit cycles to drive and improve patient outcomes.
- The practice had a number of policies and procedures to govern activity, but some were overdue a review.
- The practice did not use an interpreting service, patient’s family members were used as interpreters.
- Patient satisfaction scores were low and the practice had done nothing to address this.
- The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
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Information about services was available and displayed around the practice, however there were no posters informing of the chaperone service.
- Staff were trained and had the skills, knowledge and experience to deliver effective care and treatment.
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Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
The areas where the provider must make improvements are:
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Ensure recruitment arrangements include all necessary employment checks for all staff.
- Carry out clinical audits and re-audits to improve patient outcomes. Mitigate risks associated with fire, legionella and infection control. Ensure equipment and medicines used in patient treatment and emergencies are available, regularly checked and in date.
- Mitigate risks associated with reviewing blood test results before the prescribing of certain medicines in accordance with NICE guidance.
In addition the provider should:
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Ensure learning and outcomes from significant events and incidents are shared with all relevant members of the practice.
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Review arrangements for the patient participation group that would allow for regular meetings and patient input into the services provided.
- Review processes for patient interpreting and chaperoning.
- Review and update the practice’s procedures and policies.
Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice