Archived: Trent Valley Surgery

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