The Village Surgery

Letter from the Chief Inspector of General Practice

We had previously carried out an announced comprehensive inspection at The Village Surgery on 13 December 2017. Overall the practice was rated as inadequate and placed in special measures. We identified concerns with regards to safe, effective and well-led care provided by the practice. We served warning notices under regulations 17 (good governance) and 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The report for the comprehensive inspection can be found by selecting the ‘reports’ link for The Village Surgery on our website at: https://www.cqc.org.uk/location/1-540434907 .

The practice sent us a plan of action to ensure the service was compliant with the requirements of the regulations. We undertook a focussed inspection on 19 June 2018 to review the breaches of regulation identified at the inspection in December 2017 and to ensure the service had made improvements. At this inspection we did not review the ratings for the key questions; we will consider the practice’s ratings when we carry out a comprehensive inspection at the end of the period of special measures.

At the inspection on 19 June 2018 we found that the practice had made significant improvements and were no longer in breach of regulations 12 and 17.

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

• Pathology results were solely managed by GPs and there was a newly implemented policy that detailed the process.
• The practice were able to demonstrate there was an effective system in place for infection prevention and control.
• We found that communication in the practice had improved, there were regular staff meetings and outcomes and actions were documented.
• There was a suite of practice specific policies available for all staff.
• We found that the systems for managing patient safety alerts, significant events, complaints, DBS checks, fire safety and uncollected prescriptions were significantly improved.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – requires improvement

Are services caring? – good

Are services responsive? – good

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. Because of the concerns identified under safe and well-led the population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at The Village Surgery on 22 October 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for The Village Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 13 December 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 22 October 2015.

Our key findings were as follows:

The practice had remedied some of the shortfalls identified at our previous inspection but not all; in addition significant new concerns and regulatory breaches were identified at this inspection.

• The system for managing pathology results was informal and lacked GP clinical oversight and quality assurance.
• There were no protocols in place for medical emergencies, management of high risk medicines, business continuity planning, patient safety alerts and uncollected prescriptions.
• There was an ineffective system for managing disclosure and barring service (DBS) checks for staff.
• There was an ineffective system in place for managing staff training, the practice were only able to provide limited evidence of training.
• There was no fire risk assessment completed since 2015 and the practice did not carry out fire drills.
• Significant events were recorded and learning outcomes were identified; however learning was not shared with all staff.
• There was no clinical oversight for uncollected prescriptions.
• There were gaps in governance systems, internal meetings were not held on a regular basis and minutes were not made available to all staff when meetings were held.
• More than one percent of the patient population had been identified as carers.
• National GP survey results showed that patient satisfaction in all areas was mostly above the local and national averages.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Include information about the role of the Health Services Ombudsman in its responses to complaints.
• Review the audit system in relation to the monitoring of prescription pads in accordance with national NHS guidelines.
• Ensure a disability discrimination access assessment is completed.
• Review the current system with a view to improve the uptake of childhood immunisations.
• Review the system for monitoring and improving outcomes for patients with long-term conditions.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice