Archived: Orchard House Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard House Surgery on 5 July 2016. Overall the practice is rated as inadequate.

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

• The provider was aware of and complied with the Duty of Candour. The GP encouraged a culture of openness and honesty.
• There was system for reporting and recording significant events. However, reviews, investigations and records of significant events did not always contain dates and timelines.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, the arrangements for managing medicines, including emergency medicines and vaccines were not always effective.
• Patients we spoke with told us they always found the practice clean and had no concerns regarding cleanliness. However, the practice did not always follow national guidance on infection prevention and control.
• The practice was unable to demonstrate that all staff had received Mental Capacity Act training.
• The practice was unable to demonstrate they had safeguarding policies for children or vulnerable adults.
• Staff told us they worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. However, there were no records to confirm this.
• The practice had completed several clinical audits in the last 12 months; two of these were completed audits where the improvements made were implemented and monitored.
• Patients we spoke with told us their dignity, privacy and preferences were always considered and respected.
• Patient records were not always managed in a secure way in that computer system smart cards were left unattended in clinical rooms where the doors were left open.
• There was continuity of care and urgent appointments were available the same day.
• Information about services was available in the waiting room and on the practice website, which also contained a translation service. However, opening times and how to access services outside of opening times were not visible outside the premises.
• There were a range of mechanisms to manage the governance of the practice. However, governance arrangements were not robust or always effectively implemented.
• The principal GP had recognised the need for support and had accessed this from multiple avenues including the Local Medical Committee (LMC), neighbouring GP practices and the clinical commissioning group (CCG). In response, the CCG had provided a temporary practice manager to help maintain the day to day organisation within the practice whilst a permanent practice manager was recruited.

The areas where the provider must make improvements are:

• Ensure there are robust processes, systems and training to support staff in gaining patient consent.
• Ensure safety incidents are well recorded and that actions are taken to reduce the chance of the same thing happening again.
• Ensure all staff have the necessary employment checks including a current Disclosure and Barring Service check and employment and character references.
• Ensure all staff are up to date with attending training courses and that all newly appointed staff receive a local induction program.
• Revise risk assessments and management activities to include all risks to patients, staff and visitors.
• Ensure the practice develops systems and processes to manage infection prevention control; having due regards to National guidance.
• Revise governance processes and ensure that there are sufficient documents to govern activity and that these are reviewed and kept up to date.
• Ensure patient records are kept secure.
• Ensure Department of Health guidance is followed when managing the storage of vaccines.
• Revise medicines management procedures to help ensure vaccines and emergency medicines are in date and that there is a process for managing medicine alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• Ensure blank prescription forms are stored securely and implement systems to track and monitor their use.

In addition the provider should:

• Review opportunities for patient feedback and how to effectively promote the patient participation group.
• Review how multidisciplinary meetings are recorded.
• Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if required.
• Review the complaints recording system to ensure time frames and dates are included.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If sufficient improvements have not been made so a rating of inadequate remains 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice