Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at the Evelyn Medical Centre on 26 May 2016. Overall the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
- There was a system in place for the reporting and recording significant events. Learning was applied from events to enhance the delivery of safe care to patients, although the practice was not always clearly documenting any agreed actions as being completed.
- There were a number of issues highlighted within the daily operation of the practice dispensary, and the management of medicines and prescriptions within the practice. This included: the monitoring of prescription forms within the practice; the management of emergency medicines; checking procedures by dispensary staff; the requirement for dispensary staff to have regular competency checks, and to read and sign standard operating procedures (SOPs); and performing regular balance checks on controlled drugs.
- Some risks to patients were assessed and well managed. However, the practice needed to strengthen its approach in identifying and managing ongoing and emerging risks, and ensure appropriate documentation was in place to support this.
- Governance processes were not always sufficiently robust. For example, meetings were not always routinely documented; action plans were not updated thereby providing limited evidence of the improvements made; complaints and significant events reviews provided limited documented evidence that agreed actions had been finalised.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. A programme of clinical audit reviewed patient care and ensured actions were implemented to improve services as a result.
- The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. This approach had impacted positively on the number of unplanned hospital admissions and attendance at the out of hours’ service.
- The practice was committed to staff training and development and the practice team had the skills, knowledge and experience to deliver high quality care and treatment. The practice had an effective appraisal system in place.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice analysed and acted on feedback received from patients.
- 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 any complaints received.
- Patients said they generally found it easy to make an appointment with a GP and urgent appointments were available the same day.
- The practice had good facilities and was well-equipped to treat patients and meet their needs.
- The practice developed robust contingency planning arrangements, and were particularly effective in managing adverse winter weather conditions to ensure continuity of care for their patients. This was important due to the rural location within the High Peak.
- There was a clear leadership structure and staff told us that they felt supported by management. GPs had lead roles and provided advice and support to colleagues to enhance patient care.
- The practice reviewed the skill mix and headcount of their team to meet their patients’ needs. For example, they directly employed a community matron and care co-ordinator. A recent new practice nurse post and the appointment of a new salaried GP provided more capacity to meet increasing demands on the service. However, staffing within the dispensary had been affected by a vacancy and this had impacted on the delivery of this service. A new dispensary assistant was due to commence in the near future.
We saw the following area of outstanding practice:
- The practice had a higher percentage of older patients compared to local and national averages. The practice had taken measures to ensure they provided responsive services to meet these patients’ needs. This included developing a range of in-house services to prevent people travelling long distances to access them. This was aided by the provision of a local transport service to help patients get to the surgery. The practice also provided comprehensive support to residents at a local care home.
The areas where the provider must make improvement are:
- Ensure prescription forms are secure when in use in the practice and that accurate prescription logs are maintained.
- Strengthen processes to ensure that risk to patients and staff are effectively managed with supporting documented evidence. This should include ensuring an up to date fire safety risk assessment is available; controlling unauthorised access to consulting rooms; and the arrangements to cover the dispensary are safe and robust.
- Ensure robust governance processes are in place including the documentation of meetings; reviewing and updating any action plans and practice infection control procedures; and ensuring that complaints and significant events reviews clearly show that agreed actions have been finalised.
The areas where the provider should make improvement are:
- Review operational arrangements within the dispensary to ensure that: dispensed items are checked by a second person to minimise the risk of dispensing errors; that dispensary staff have regular competency assessments; that regular Controlled Drug balance checks are carried out; that staff using Standard Operating Procedures read and sign these.
- Review the monitoring arrangements and recording of cleaning schedules.
- Maintain an audit trail to demonstrate actions taken in response to safety alerts, and the receipt of new guidance, for example National Institute for Health and Care Excellence (NICE).
- Regularly review all policies and procedures to ensure they are accurate and up-to-date.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice