We carried out an announced comprehensive inspection at Gade Surgery on 1 December 2016. Overall the practice was rated as good. However, we identified a breach of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Gade Surgery on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 7 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 1 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
On this focused inspection we found that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.
The practice is now rated as good for providing safe services.
Our key finding was as follows:
- Sufficient arrangements were in place for the management of Patient Group Directions (PGDs) and they were appropriately reviewed, signed and countersigned. (Patient Group Directions are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment).
Additionally where we previously told the practice they should make improvements our key findings were as follows:
- The practice kept prescription pads securely and monitored their use.
- Appropriate recruitment checks had been undertaken and documented prior to the employment of new staff members.
- Actions to reduce the risks identified by the fire and Legionella risk assessments were completed and recorded. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings). Water temperature checks were completed and recorded. Fire extinguishers were checked to ensure they were working properly.
- The practice risk assessed how it transported patient identifiable data between its two sites and staff understood the precautions they needed to take to reduce the identified risks.
- We saw that a process was in place and adhered to for monitoring the completion of staff training. Staff received training that included: adult and child safeguarding, fire safety, chaperoning and basic life support. Most of the training was provided by the use of an e-learning facility. All newly employed staff had received a training needs assessment and a process was in place to ensure all staff received one by the completion of this year’s staff appraisal process on 31 March 2018.
- During our inspection on 1 December 2016 we found the practice’s policy for obtaining and recording patient consent for procedures was not always followed and the consent process was not monitored. During this focused inspection we reviewed the records of seven patients who had recently received joint injections, travel vaccinations or baby immunisations and found that in all the cases we looked at the appropriate consent was obtained and documented. We saw that the practice monitored the process for seeking consent to minor procedures appropriately. We looked at three quarterly audits completed between April and December 2017 which showed the 26 patients who had received a minor procedure in that time all had their consent obtained and recorded in accordance with the practice’s policy.
- Following our inspection in December 2016 the practice had completed a piece of work to ensure its carers register (those patients on the practice list identified as carers) was correct and accurately reflected those patients who were active in a carer role. This had reduced the number of carers identified from 122 to 103. Through a proactive approach from staff this was increased and at the time of this focused inspection on 7 March 2018 the practice had identified 124 patients on the practice list as carers. This was approximately 1% of the practice’s patient list. Of those, 93 (75%) had been invited for and 22 had accepted and received a health review since 1 April 2017. Dedicated carers’ notice boards in the reception areas provided information and advice including signposting carers to support services. A member of reception staff was the practice’s carers’ lead (or champion) responsible for providing useful and relevant information to those patients and attending the relevant locality meetings.
- Practice specific policies were implemented and were available to all staff. We looked at examples of these including the practice’s recruitment, consent, chaperoning and child safeguarding policies. We found these were regularly reviewed and updated and contained the appropriate information which reflected the practice’s current processes.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice