Archived: Trent Valley Surgery

Updated 1 October 2015

Trent Valley Surgery provides primary medical services to 4,148 patients from two sites, the primary site being at 85 Sykes Lane, Saxilby and a branch site at Main Street, Torksey. Both locations were visited during the course of our inspection. Both locations have a dispensary which dispense to 2,499 (60%) eligible patients.

The practice serves a rural community and the Sykes Lane location shares the premises with another practice, The Glebe Practice.

The practice has two partner GPs, a nurse practitioner, a nurse and a phlebotomist. They are supported by a temporary practice manager, reception and administrative staff.

The practice is registered incorrectly with the Care Quality Commission. It is registered as an individual, when in effect it is a partnership with two GP partners.

The practice has high percentage of older patients, notably aged between 65 and 75 and a lower percentage of patients under the age of 18 when compared nationally. The practice is located in an area of low deprivation. The practice has a high percentage of patients with long term health conditions and with caring responsibilities when compared nationally.

The practice holds a General Medical Services (GMS) contract for the delivery of general medical services..

The service is commissioned by Lincolnshire West Clinical Commissioning Group.

The Sykes Lane surgery is open between 8am and 6.30pm Monday to Friday and the Torksey surgery from 10.30am to 2.30pm GP consultations are available from 8.30 am to 6pm. Appointments with nurses and phlebotomists were available from 8.10am.

The practice has opted out of the requirement to provide GP consultations when the surgery is closed. Out- of- Hours services are provided through Lincolnshire Out-of-Hours Service which is provided by Lincolnshire Community Health Services NHS Trust. Patients access the service via NHS 111.

Updated 1 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trent Valley Surgery on 30 June 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe and well led services. It was also inadequate for providing services for; older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It was rated as ‘requires improvement for providing effective services and responsive services. It was good for providing caring services.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe.

• There were inadequate measures in place to deal with medical emergencies and to enable the practice to function to due foreseeable events such as loss of power, flooding or fire.

• Medicines were not subject to checking by a second person prior to being dispensed. Some medicines were stored in-appropriately.

• Not all staff had received appropriate training to help them recognise suspected abuse in children and vulnerable people and some were unable to demonstrate what action they would take in those circumstances.

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• There was insufficient assurance to demonstrate people received effective care and treatment. For example we found that the practice did not have a system to ensure nursing staff and GPs routinely referred to guidance and guidelines from the National Institute for Health and Care Excellence. There was no effective process to manage safety alerts and disseminate them to staff.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity. Patient feedback obtained through patient surveys rated the practice very highly.

• Urgent appointments were usually available on the day they were requested.

• Patient records held in paper format were not stored securely so as to prevent unauthorised access.

• The practice had ineffective leadership and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure that systems are in place to ensure the continued suitability of staff to work in a healthcare environment.
• Ensure staff receive training to ensure they can deliver safe and effective healthcare.
• Ensure that incidents, near misses and complaints are recorded correctly, investigated and any learning cascaded to staff.
• Ensure that suitable equipment and plans are in place to enable staff to deal with medical emergencies.
• Have an effective business continuity plan to deal and foreseeable events that may prevent the practice functioning normally.
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Introduce an appropriate system to ensure medicines are dispensed safely.
• Ensure that there are the appropriate procedures in place to ensure the safe storage of medicines.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Ensure that all staff are covered by an appropriate level of professional indemnity insurance.
• Establish a clear leadership structure with the capacity and support to ensure that improvements to the service can be delivered.
• Patient records stored in paper format should be stored securely so as to prevent unauthorised access and to mitigate the risks associated with such events such as fire.
• Ensure the provider CQC Registration is brought up to date.

The areas where the provider should make improvement are:

• Establish a Patient Participation Group
• Update their practice information leaflet to reflect changes in out-of-hours arrangements.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 October 2015

The practice is rated as inadequate for the care of people with long term conditions. The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. However, not all these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met.

Updated 1 October 2015

The practice is rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. The practice offered all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 1 October 2015

The practice is rated as inadequate for the care of older people. The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive . The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs

Updated 1 October 2015

The practice is rated as inadequate for the care of working age people (including those recently retired). The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 1 October 2015

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

93.5% of people experiencing dementia had received an annual medication review. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

Updated 1 October 2015

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had 32 patients on the learning disability register. Most of these patients were in a large residential care home and the practice conducted weekly ‘ward round’ type visits to meet these patients’ needs.

To ensure reception staff were aware a board behind the reception desk, that was visible to staff only, detailed those patients who were considered vulnerable.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Most staff we spoke with knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities regarding safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.