Archived: The Glebe Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Glebe Practice on 30 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice inadequate for providing safe services. It was rated as requires improvement for being well led and rated as good for providing effective, caring and responsive services. It requires improvement 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).

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. However the practice had very recently undertaken an audit of many of their systems and processes and were putting action plans in place to address issues raised. These had not yet been implemented and therefore the proposed changes were not yet embedded.

• Not all clinical staff had received appropriate training in safeguarding to ensure they were up to date with current procedures.

• Some staff were not clear about reporting incidents, near misses and concerns and there was limited evidence of learning and dissemination to staff.

• There was not a robust system in place to deal with complaints raised by patients.

• A significant number of patients gave us feedback about the practice and were overwhelmingly positive about their care. They told us they were treated with compassion and dignity.

• Urgent appointments were usually available on the day they were requested. However some patients said that they had to wait a long time to get through by phone to make an appointment.

The areas where the provider must make improvements are:

• Ensure staff receive up to date training to the appropriate level to ensure safeguarding of vulnerable adults and children.
• Have a system in place to ensure significant events, near misses and complaints are recorded correctly, investigated and any learning cascaded to staff.
• Implement a robust system for dealing with safety alerts.
• 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 and up to date 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 where required staff are covered by an appropriate level of professional indemnity insurance.
• Implement a robust system for recording and actioning medication errors.
• Ensure dispensary staff have either Disclosure and Barring Service checks in place or that it has been risk assessed.
• Ensure all emergency medicines and equipment are in date.
• Have an effective business continuity plan in place to deal with unforeseeable events that may prevent the practice functioning normally which includes mitigating risks and actions, including having a copy available at the branch surgery.

The areas where the provider should make improvement are:

• Ensure adequate arrangements are in place to maintain patient privacy at the branch surgery including privacy curtains in the clinical rooms and glass in consultation room doors are suitably screened.
• Ensure all meetings are minuted.
• Ensure standard operating procedures for the dispensary include a competency section.
• Have in place a robust cleaning schedule to give assurance specific rooms are being cleaned to an appropriate standard.
• Ensure staff are aware of the leads for different areas such as safeguarding and infection control.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice