Crosby House Surgery

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection at Crosby House Surgery on the 25 October 2016. This was to follow up on concerns identified at an inspection in January 2016, where the practice was rated as requires improvement overall with an inadequate rating in the well led domain. Following the inspection on the 25 October the overall rating for the practice is good.

Our key findings across all the areas we inspected were as follows:

• The practice had acted on the findings of the previous inspection and had completed all the actions from their action plan.
• Crosby House Surgery had undergone a significant refurbishment since the last inspection. This included complete redecoration; new flooring throughout the practice, the installation of new furniture and other practice facilities has been updated.
• 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.
• 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 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 should make improvement are:

• Display the out of hours contact details on the front door of the building, for patients who may visit the practice when they are closed.

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 Crosby House Surgery on 20 January 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. When there were safety incidents reviews and investigations were conducted, but action plans were not always carried out in a timely fashion
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment, actions identified to address concerns with infection control practice had not been taken, and prescription pads were not appropriately monitored.
• Not all staff had received appropriate training.
• The practice had limited formal governance arrangements.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review. Actions outlined in policies were not always followed.
• There was an interpreter service but not all staff were aware of this.
• There was no hearing loop in reception.
• Complaints were not always responded to in a timely manner and patients were not always provided with information about the Ombudsman.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Data showed patient outcomes were high in some areas, similar in some areas and low in others compared to the locality and nationally. Audits had been carried out and we saw evidence that audits were driving improvement in performance to improve patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested.
• The practice had proactively sought feedback from patients. It had a patient participation group and it was recruiting new members for this.

The areas where the practice must make improvements are:

• Introduce robust processes to ensure action plans from significant events are carried out in a timely manner.
• Take action to address identified concerns with infection prevention and control practice.
• Address the monitoring of blank prescriptions.
• Implement recruitment arrangements that include all necessary employment checks for all staff.
• Provide staff with appropriate training to fulfil their roles to include safeguarding, infection control, basic life support, health and safety training.
• Implement appropriate processes to monitor and minimise risks related to the premises, such as fire safety, legionella, slips and falls, and spillages of clinical substances.
• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. This must include governance arrangements to address provision of appropriate policies and guidance for staff, risks related to emergency equipment, prescriptions, infection control, training of staff, and the maintenance of the premises.

In addition the provider should:

• Improve staff awareness of the translation services available and how they can provide assistance to patients who may need access these services.
• Respond to complaints in a timely manner and provide all patients with information about the Ombudsman.
• Put in place further arrangements for assisting people with hearing difficulties, for example providing a hearing loop.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups the practice will be re-inspected within six months after the report is published. If, after re-inspection, the practice has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place the practice into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice