Archived: Dunstan Village Group Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Dunstan Village Group Practice on 20 April 2017. Overall the practice was rated as requires improvement. The practice was rated as requiring improvement for providing safe and well led services; and good for providing effective, responsive and caring services. The full comprehensive report on the 20 April 2017 inspection can be found by selecting the ‘all reports’ link for Dunstan Village Group Practice on our website at www.cqc.org.uk.

This inspection was an announced follow up inspection carried out on 6 October 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 20 April 2017. This report includes our findings in relation to those requirements.

Overall the practice is now rated as good and good for providing safe and well led services.

The practice had made improvements and addressed the issues identified in the previous inspection. Improvements included:

• A review of the governance systems in place to ensure the quality and safety of the service. For example, there were improvements in the monitoring systems for training, recruitment, cleaning of the premises and managing uncollected prescriptions and significant events.
• The practice had implemented a new system for managing and responding to safety alerts. The practice had reviewed previous medication alerts.
• All staff had received appropriate recruitment checks and records were kept.
• The practice had correctly registered with us to carry out the regulated activity of minor surgery.

In addition:-

• The practice had actively sought ways to identify carers in order for them to offer appropriate support. There was a designated area of the waiting room for carers’ information.
• Information about how to make a complaint was displayed in the waiting room and information for patients had been updated.
• All staff had received training in safeguarding and the Mental Capacity Act relevant to their role.
• The practice had implemented a system to record the stock and use of blank prescription forms used for home visits.
• The locum induction pack had been updated to provide locum GPs with the necessary information in order for them to carry out their role.

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 Dunstan Village Group Practice on 20 April 2017. Overall the practice is rated as requires improvement. The practice is rated as requiring improvement for providing safe and well led services; and good for providing effective, responsive and caring services.

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

• The practice is situated in a purpose built health centre shared with another practice. The practice was clean and had good facilities including disabled access and a hearing loop.
• A high number of patients could not speak English and the practice used interpreters and translation services and offered longer appointments when necessary.
• The practice was delivering minor surgery, a regulated activity they were not legally registered for with the Care Quality Commission.
• Some staff had not received relevant recruitment checks including Disclosure and Barring Service (DBS) check. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• The practice had recently participated in a local scheme with the medicines management team to improve prescribing safety, using the most cost effective medicines, and to improve outcomes. However, the practice did not have a robust recording system to deal with patient and medication safety alerts.
• Although there was a system for reporting and recording significant events, there were some incidents that had not been reported or recorded appropriately. The practice did not analyse significant events over time to identify any trends to prevent reoccurrence.
• Staff received training relevant to their role however the non-clinical staff and nursing staff had not received safeguarding training relevant to their role or Mental Capacity Act training.
• The practice had arrangements to respond to emergencies and major incidents.
• Patients’ needs were assessed and care was planned and delivered in line with current legislation.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was no information about how to complain displayed in the waiting room or on the website and patients had to request this at reception. The information available at reception needed to be updated to incorporate the details of who the patient could complain to if they were not happy with the service provided. The practice sought patient views about improvements that could be made to the service; including having a patient participation group (PPG) and acted, where possible, on feedback.
• The staff were dedicated to providing person centred care and worked well together as a team. However, the governance arrangements for the practice needed improving in order to deliver care safely.

There was an area of outstanding practice:

• The practice recognised the benefits of exercise to patients’ health and was working towards every patient receiving advice during a consultation. The practice carried out consultation audits to help achieve its aim.

The areas where the provider must make improvements are:

• Ensure they are correctly registered with the CQC and improve their understanding of the regulations.
• Ensure all staff have appropriate recruitment checks prior to employment and maintain recruitment records.
• Ensure governance systems for the practice are improved to outline roles of accountability, improve adherence to protocols; and improve the records for monitoring systems to ensure patient safety. For example, monitoring systems for training, recruitment, cleaning of the premises and managing uncollected prescriptions and significant events. In particular, the practice must improve the current system in place for cascading and recording actions taken as a result of receipt of a medication safety alert; and to also check they have acted on previous safety alerts.

The areas where the provider should make improvements are:

• Make information about how patients can make a complaint readily available.

• Update the complaints procedure to incorporate the choice of contact details of who the patient can complain to if they are not happy with the service provided.

• Ensure all staff receive safeguarding training and Mental Capacity Act training appropriate for their role.

• Keep records of the stock and use of blank prescription forms for home visits.

• Improve the number of patients identified and registered as carers.

• Improve the contents of the locum information pack so that locum GPs have access to all necessary information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice