The Parks Medical Practice Also known as Grange Park Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Parks Medical Practice on 20 January 2017. The overall rating for the practice was Good however breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to:

Regulation 12 (RA) Regulations 2014, safe care and treatment.

The full comprehensive report from the inspection on 20 January 2017 can be found by selecting the ‘all reports’ link for Parks Medical Practice on our website at www.cqc.org.uk

This inspection was a focused follow up inspection carried out on 7 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified on our previous inspection on 20 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as ‘Good’.

From the inspection on 20 January 2017, the practice was told they must:

• Improve measures related to fire safety so that actions identified in a recent fire risk assessment were implemented.
• Ensure risk assessments are undertaken where no DBS checks for non clinical staff carrying out the role of the chaperone.
• Meet the requirements of the Health and Safety at Work Act 1974 so that all eligible clinical staff had received the appropriate vaccinations, for example Hepatitis B.

We also told the practice that they should make improvements to the follows areas:

• Consider offering health checks to patients aged 75 years and over.
• Implement a systematic approach to the management of infection prevention and control, for example through annual audits.
• Ensure further identification of significant events including incidents and near misses logged by the dispensaries and consider these through the incident reporting process.
• Consider recording verbal complaints to ensure lessons learnt from these formed part of the annual trend analysis.
• Continue to encourage attendance at safeguarding meetings from external agencies.
• Ensure all staff were supported by providing appropriate supervision and appraisal.
• Implement a systematic approach to the management of exception reporting for QOF to ensure practice wide quality improvements.

Our key findings were as follows:

• Actions identified in a recent fire risk assessment had been implemented to ensure fire safety.
• Systems were in place for identifying, assessing and mitigating risk in relation to non-clinical staff undertaking chaperone duties. Non clinical staff that undertook chaperone duties had been risk assessed for the need of a Disclosure and Barring Service (DBS) check with appropriate safeguards and were trained for this role.
• We were sent confirmation that all eligible clinical staff had received the vaccinations as appropriate.
• The practice confirmed that there were alternate arrangements for eligible patients in the 75 years and over age group to receive an annual check with a GP. For example through medication reviews and long term conditions reviews.
• A six monthly infection control audit schedule was now in place at each branch with the first audit cycle completed during July 2017.
• Significant events including incidents and near misses logged by the dispensaries were now included at local team meetings, quarterly branch meetings and quarterly department meetings and were part of the annual significant event analysis and learning.
• A form was available to enable staff to record verbal complaints and comments which was discussed during practice meetings and part of the annual significant event analysis and learning.
• The practice had escalated the non-attendance of staff from external agencies in safeguarding meetings to the locality manager and agreements were in place to improve attendance.
• The practice confirmed that appraisals that were outstanding had been completed in February 2017.
• The practice confirmed that there was an effective process for exception reporting including a central reminder system operated by a dedicated QOF staff member. This included a referral system to a GP highlighting non-attendance to ensure appropriate decision making which included prompting patients to attend for the relevant monitoring and checks.

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 The Parks Medical Practice on 20 January 2017. Overall the practice is rated as good.

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.
• Risks to patients were assessed and well managed in most areas.
• 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.
• 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 and easy to understand. 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 named GP and we saw evidence of continuity of care, with urgent appointments available the same day.
• The practice offered a range of services and was well equipped to treat patients and meet their needs.
• Veterans were identified and recorded on the practice computer system to ensure support to ex Armed Forces.
• There was a clear leadership structure and staff felt supported and developed by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure that actions are completed to mitigate risks identified in relation to the health and safety of service users, for example actions pertaining to the fire safety risk assessment.

• Ensure risk assessments are undertaken where no DBS checks for non clinical staff carrying out the role of the chaperone.
• Implement a process to ensure all clinical staff receive appropriate vaccinations for example Hepatitis B.

In addition, the areas where the provider should make improvements are:

• Consider offering health checks to patients aged 75 years and over.
• Implement a systematic approach to the management of infection prevention and control, for example annual audits.
• Ensure further identification of significant events including incidents and near misses logged by the dispensaries and consider these through the incident reporting process.
• Consider recording verbal complaints to ensure lessons learnt from these form part of annual trend analysis.
• Continue to encourage attendance at safeguarding meetings from external agencies.
• Ensure all staff are supported by receiving appropriate supervision and appraisal.
• Implement a systematic approach to the management of exception reporting for QOF to ensure practice wide quality improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice