Archived: Crawford Street Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crawford Street Surgery on 11 February 2016. 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. However, the practice recognised that clinical meetings needed to be minuted to provide documentary evidence of discussion of lessons learned and agreed decisions and action.
• Risks to patients who used services were assessed and managed. However, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. There were some deficiencies in safeguarding training, medicines management and in the documentation relating to the practice’s recruitment processes. In addition, whilst there was an evacuation plan in place no fire drills had been undertaken in the last six months.
• Although CCG led clinical audits had been carried out to drive improvement, two practice initiated audits showing the completion of the full audit cycle had not been concluded at the time of the inspection.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 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 all GP staff are trained in safeguarding children to the appropriate level in accordance with national guidance and address gaps in training in the safeguarding of vulnerable adults.
• Complete and record the risk assessment of the practice’s decision not to stock medicine excluded from the emergency medicines kit. Ensure a record of prescription pads batch numbers is kept to maintain prescription security.
• Ensure patients are fully protected against the risks associated with the recruitment of staff; in particular in ensuring all appropriate pre-employment reference checks are documented in staff records.

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

• Ensure clinical meetings are minuted to provide an audit trail of discussion and agreed decisions and actions.
• Produce a written cleaning schedule to show work completed and record monitoring checks.
• Organise and document more regular fire drills.
• Ensure full cycle audits currently underway are completed.
• Display information in the patient waiting area about the practice’s vision and values.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice