21 September 2016
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Field House Surgery on 6 January 2016. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment, Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing.
On 21 September 2016 we undertook a unannounced follow up inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Field House Surgery on our website at www.cqc.org.uk.
At this inspection we found that the practice had satisfied the requirements of the notices in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment, Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance. However there continued to be issues in relation to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing.
Specifically we found that:
- There were systems in place for reporting and recording significant events and staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
- Risks to patients were assessed and managed, including those relating to the management of medicines. However there continued to be issues in relation to the deployment of sufficient staff.
- Staff assessed patients’ needs and delivered care. However there was limited documented evidence that a formal process was in place to review and assess clinical guidance when it was issued. Staff had the skills, knowledge and experience to deliver effective care and treatment.
- The majority of patients said they were treated with compassion, dignity and respect.
- Patient feedback showed that patients did not always feel satisfied with how they could access care and treatment.
- Patients reported that access to a named GP and continuity of care was not always available, although urgent appointments were usually available the same day.
- Information about services and how to complain was available and easy to understand.
- 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 in the practice. However staff said they did not always feel supported by the management team at the provider’s head office.
- 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.
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The practice had a number of policies and procedures to govern activity and systems to monitor quality improvement.
However there was an area of practice where the provider must make improvements;
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Ensure that appropriate levels of staffing are maintained at all times.
There were areas of practice where the provider should make improvements;
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Follow their policy and national guidance to track blank prescriptions forms through the practice.
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Prioritise attendance at relevant infection prevention and control (IPC) training for the health care assistant IPC lead.
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Implement a system to ensure patients’ treatment was reviewed and updated if necessary following the issuing of updated clinical guidelines.
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Implement a process so patient records are summarised in a timely manner.
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Develop a home visit protocol.
The overall rating awarded to the practice following our full comprehensive inspection on 6 January 2016 remains unchanged. The practice will be re-inspected in relation to their rating in the future.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice