Sidley Medical Practice Also known as Dr Lawton & Partners

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of Sidley Medical Practice on 21 August 2017. This was to follow up on a warning notice the Care Quality Commission served following an announced focused inspection on 16 June 2017 when the practice was rated as inadequate for providing well led services.

The warning notice was served relating to regulation 17: Good Governance of the Health and Social Care Act 2008. The timescale given to meet the requirements of the warning notice was 18 August 2017.

The June 2017 inspection highlighted several areas where the provider had not met the standards of regulation 17: Good governance. These included:

• Clinical audits did not demonstrate quality improvements to patient care.
• Staff training and appraisals did not ensure all staff had received up to date training or were aware of their learning needs.
• Patient safety and medicines alerts were not effectively managed and the practice could not provide evidence they had reviewed all alerts in a comprehensive way.
• The practice was unable to evidence they had reviewed and completed all the highlighted actions in the infection control audit. Cleaning records did not include items of medical equipment and the practice could not demonstrate regular cleaning of medical equipment took place.
• Not all staff were aware of how to identify and report a significant event.
• Governance arrangements did not ensure background checks were carried out for staff prior to employment.
• The practice had failed to seek and act on feedback from staff and had failed to identify that many staff were unaware of the practice vision and business plan.

At this inspection in August 2017 we found that actions had been taken to improve the provision of well led services. Specifically the practice had:

• Reviewed the governance arrangements for all areas of practice outlined in the warning notice.
• Held a meeting with all staff to offer training on significant events to provide an understanding of their role and the terminology.
• Improved the arrangements for dealing with patient and safety alerts received from various sources, including the Medicines and Healthcare Products Regulatory Agency (MHRA).
• Reorganised the staffing structure and assigned a new designated staff lead to deal with personnel and recruitment documentation.
• Allocated protected time for staff to undertake essential training such as safeguarding, fire safety and information governance.
• Commenced or completed staff appraisals for all staff that had been in post for over 12 months.
• Reviewed the infection control action plan and ensured all outstanding actions had been completed or had a date specified for completion within a reasonable timeframe. Cleaning records demonstrated clinical equipment was being regularly cleaned and checked.
• Undertaken further clinical audits and demonstrated improvements to patient care and outcomes.
• Improved communication with staff at all levels and actively engaged with their ideas and suggestions for developing the practice.

At our previous inspection in June 2017, we rated the practice as inadequate for the provision of well-led services and an overall rating of requires improvement. At this inspection we have focused on the warning notice findings in respect of the well led section of our report. We found that the practice had taken action to address the breaches of regulation set out in the warning notice issued in July 2017. However, the current ratings will remain until the practice receives a further comprehensive inspection to assess the improvements achieved against all breaches of regulation identified at the previous inspections.

The focused report published on 28 July 2017 should be read in conjunction with this report.

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 Sidley Medical Practice on 23 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Sidley Medical Practice on our website at www.cqc.org.uk.

This was an announced focused inspection carried out on 16 June 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 23 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• There was no formalised process for reviewing, assessing risk and taking action for patient and medicine safety alerts. There was no record of previous alerts that had been acted on and an alert from April 2017 was yet to have actions taken.
• Not all staff were aware of the process for reporting and recording significant events. Learning from events was shared with staff directly involved or disseminated through line managers.
• There were gaps in staff training. Some clinical and non-clinical staff had not received adult safeguarding training and one non-clinical member of staff had not received child safeguarding appropriate to their role. Some staff still had not received training in fire safety and information governance.
• Recruitment procedures had improved, although references for one member of clinical staff had not been requested prior to employment.
• Staff appraisals had been commenced but not all staff, who were eligible, had received an appraisal in the last 12 months.
• The practice had undertaken some clinical audits but there was little evidence of improvements to the quality of patient care.
• An infection control audit, carried out in March 2017, did not identify interventions required, which member of staff was responsible and a timescale for action. Completed actions were not documented.
• Care plans were available for a variety of long term condition management but not all clinical staff accessed or used them.
• There was a lack of awareness of the practice vision and business plan amongst staff and not all staff felt involved in discussions about how to run and develop the practice.
• Patient group directions and patient specific directions were administered in line with legislation.
• Practice policies were practice specific and up to date.
• The practice had designated a GP as the overall clinical lead and other GP partners had been assigned lead roles.

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

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

In addition the provider should:

• Ensure that alerts for children and adults at risk which are placed on the practice computer are also placed on family or other household members’ records, as appropriate.

At our previous inspection on 23 August 2016, we rated the practice as requires improvement for providing safe, effective and well led services. The arrangements for reviewing and implementing action for patient and medicine safety alerts, staff awareness of significant event reporting and processes, infection control audit documentation, staff recruitment files, staff training records, appraisals and clinical audits were ineffective.

At this inspection we found that sufficient improvements had still not been fully introduced or implemented. Consequently, the practice is rated as requires improvement for providing safe and effective services and inadequate for well led services.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service 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