North Leverton Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Leverton Surgery on 23 May 2017. The overall rating for the practice was Good but with Requires Improvement for safety. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for North Leverton Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 November 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 23 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

The provider had made the following improvements to address legal requirements :

• Procedures were in place to ensure medicines provided in compliance aids were packaged safely to reduce the risk of patient harm.
• Medicine fridge temperature monitoring had been improved in relation to provision and resetting of thermometers to maintain the effectiveness and safety of the medicines.
• Security arrangements for keys to the dispensary and controlled drug storage area had been improved.
• Procedures had been implemented in accordance with regulations for controlled drugs which require destruction.
• Records for controlled drug stock had been improved and accurate records were maintained.

The provider had also made improvements in the following areas:

• The fire risk assessment action plan had been reviewed and action had been completed to improve fire safety.
• The legionella risk assessment action plan had been reviewed and measures were being taken to minimise risk.
• Procedures were in place to try to improve uptake for childhood vaccinations. The practice had developed protocols to support practice when patients did not attend for routine vaccination. This included sending three letters to invite them to attend for vaccination and putting alerts on the electronic patient records. Where patients did not attend for vaccination after three letters the clinicians were informed and, where clinicians felt this was necessary, the patients were referred to the health visitor. Following discussion at the inspection staff said they would also add this area as a standing agenda item to their practice meetings to ensure ongoing monitoring of patients who did not attend.
• Systems had been improved to assist the practice to identify carers. They had developed a carers leaflet and patient questionnaire which was included in new patient packs; they had developed a template for clinicians to assist them to identify and record carers and developed a carer’s protocol to support practice. One of the practice administrators monitored the numbers of carers on the register monthly. We observed the number of carers identified had increased from 18 (0.6% of the patient list) at the last inspection to 42 (1.5% of the patient list). We observed a variety of information to support carers was displayed in the practice and these patients were invited for flu vaccines. Organisations which could offer advice for carers, such the local Social Prescribing Team, were invited to the flu clinics.

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 North Leverton Surgery on 23 May 2017. 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 a system in place for reporting and recording significant events.
• The practice had systems, processes and practices to minimise risks to patient safety although some procedures relating to the dispensary service required improvement. The practice also needed to review the fire risk and the legionella risk assessment action plan to ensure all actions have been completed and to ensure adequate measures were being taken to minimise risk.
• 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 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. Improvements were made to the quality of care as a result of complaints and concerns.
• There was continuity of care, with urgent appointments available the same day. However, some patients did not always find it easy to make a routine appointment.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

• The practice had 32 patients with learning disabilities which equated to 1% of the patient population compared to the national average of 0.5%. The practice ensured these patients were regularly reviewed and monitored uptake of annual health checks monthly. The NHS England target for uptake of annual health checks for patients with a learning disability is 75%. During 2016/17 the practice achieved 97% uptake. The practice provided a wide range of information in easy ready format to enable patients with a learning disability to be involved with their care and the practice offered longer appointments for patients with a learning disability. The GPs and a member of the administration team had completed learning disability training on annual basis. Members of staff from two local care homes told us their patients with a learning disability received an excellent service from the practice and they ensured patients were involved in their care.

The areas where the provider must improvement are:

• Ensure medicines that are provided in compliance aids are packaged safely to reduce the risk of patient harm.

• Ensure fridge temperatures are monitored correctly in relation to provision, calibration and resetting of thermometers to maintain the effectiveness and safety of the medicines.

• Review access and security arrangements for keys to the dispensary and controlled drug storage area.

• Implement procedures in accordance with regulations for controlled drugs which require destruction.

• Develop and implement procedures to ensure accurate records for controlled drug stock are maintained.

The areas where the provider should make improvement are:

• Review the fire risk assessment action plan and ensure all actions have been completed.

• Review the legionella risk assessment action plan to ensure adequate measures are being taken to minimise risk.

• Improve uptake for childhood vaccinations.

• .Review the systems in place to identify carers.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice