Victoria Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Victoria Surgery on 8 May 2017. The overall rating for the practice was good, with requires improvement for providing safe services. The full comprehensive report on the 8 May 2017 inspection can be found by selecting the ‘all reports’ link for Victoria Surgery on our website at www.cqc.org.uk.

We undertook a desk based inspection on 16 October 2017 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 8 May 2017. This report only covers our findings in relation to those requirements.

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

Our key findings from this inspection were as follows:

• Effective procedures were in place to ensure all staff had a Disclosure and Barring Service (DBS) and this included all staff who had unsupervised contact with patients.
• Patient Group Directions were up to date and had been signed by the nurses and a GP to ensure the nurses had the legal authorisation to administer the relevant medicines.
• Complaints information for patients was easily available and included correct information for patients who wanted to escalate their complaint if they were dissatisfied with the response from the practice. Staff at the practice confirmed this information was available in the waiting room and at reception.
• Improvements had been made to infection prevention and control in the practice. The practice had an infection control lead, who had completed relevant training and received updates. An infection control action plan was in place and actions had been completed.
• Infection control training had been completed by all staff, including dispensary staff.
• The practice recorded the receipt and disposal of patient returned medicines.
• Policies and procedures were in place; however they were not all up to date. One of the GPs had weekly, dedicated time to update the policies and procedures. The practice had recently commissioned a new website and all their policies and procedures would be available on there for staff to access easily.

The areas where the provider should make improvement are:

• Continue to update all policies and procedures.

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 Victoria Surgery on 4 November 2015. The practice was rated as good for providing caring and responsive services and requires improvement for providing safe, effective and well led services. Overall the practice was rated as requires improvement. We carried out a focussed, desk based review on 28 June 2016 and found some improvements had been made. The practice was rated as good for providing safe and effective services; well led services were not inspected during the desk based inspection. The full comprehensive reports on the 4 November 2015 and 28 June 2016 inspections can be found by selecting the ‘all reports’ link for Victoria Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Victoria Surgery on 8 May 2017. Overall the practice is rated as good, with requires improvement for providing safe services.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Health and safety risks to patients were assessed and well managed. However, two members of nursing staff and the dispensary delivery driver did not have a Disclosure and Barring Service check completed by the practice.
• Systems and processes were in place to ensure the cleanliness of the practice. An infection control audit had been undertaken and the action plan was going to be reviewed following the completion of the training of the identified infection control lead. The majority of staff, including all clinical staff, had received up to date infection control training. Infection control training had not been completed by all dispensary staff.
• The arrangements for managing medicines, including emergency medicines in the practice kept patients safe, however the practice did not record the disposal of patient returned medicines.
• Patient safety alerts were logged, shared and initial searches were completed and the changes effected.
• Patient Group Directions (PGDs) to allow nurses to administer medicines including childhood immunisations were being used; however, these had not been signed on behalf of the practice or by the nurses. This meant the nurses did not have the required legal authorisation to administer the relevant vaccines which are Prescription Only Medicines.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Appraisals had been completed for all staff.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available however this had to be obtained from the reception staff. The patient complaints leaflet did not contain the correct information for patients about how to escalate a complaint. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• 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 sought feedback from staff and patients, which it acted on. Policies and procedures were in place; however they were not all up to date.

We saw one example of outstanding practice:

• The practice provided GP appointments twice a week for children aged three to 18 at a nearby independent boarding school. The GPs undertook medical assessments in conjunction with the nurses at the school for all new boarding children which included children from countries with an emerging economy. The school reported that the practice provided holistic care to children living away from home, directly liaised with children’s parents, ensured access to a female GP if this was requested, and provided excellent support to the nursing team at the school. The practice confirmed that by providing this service they were able to guarantee pupils access to woman’s health checks, including contraception, an age appropriate immunisation programme and that patient appointments were not reduced from the practice links with the school.

The areas where the provider must make improvement are:

• Ensure that all clinical staff have a Disclosure and Barring Service (DBS) check and that a risk assessment is undertaken to determine whether a DBS check is required for non-clinical staff.
• Ensure that Patient Group Directions are up to date and signed on behalf of the practice and by the nurses to ensure the nurses have the required legal authorisation to administer the relevant medicines.

The areas where the provider should make improvement are:

• Ensure that the patient complaint leaflet is easily available and reviewed to ensure that it contains the correct information for patients about how to escalate their complaint if they were dissatisfied with the response from the practice.
• Ensure that the infection control audit completed in April 2017 is reviewed and an action plan agreed following the completion of the training of the identified infection control lead. Ensure infection control training is completed by all dispensary staff.
• Ensure all policies and procedures are updated.
• Record the disposal of patient returned medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice