Archived: Broadway Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Broadway Surgery on 19 October 2016. Overall the practice is rated as good.

Broadway Surgery was subject to a previous comprehensive inspection in February 2016 where the practice was rated as inadequate and was placed into special measures. Following our inspection of the practice in February 2016, the practice sent us an action plan detailing what they would do to meet the regulations. We undertook this second comprehensive inspection on 19 October 2016 to check that the provider had followed their action plan and to confirm that they now met the regulations. We found that the practice had made significant improvements since our previous inspection. The practice is now rated as good overall.

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

• There was now an open and transparent approach to safety and an effective system in place for reporting and recording significant events. We saw evidence these were investigated and that learning was shared with staff.
• Risks to patients were assessed and well managed. This included arrangements for managing medicines, including emergency drugs, vaccines and the prescribing of high risk medicines.
• Arrangements were now in place to manage the care and treatment of patients with long term conditions. Practice performance against the quality and outcomes framework (QOF) had significantly improved as a result.
• Immunisation rates were now relatively high for all standard childhood immunisations.
• 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. This included up to date training on basic life support, safeguarding, infection control and the role of the chaperone.
• Patient satisfaction had improved. Seventy six per cent of respondents to the national GP patient survey stated that they would recommend their GP surgery to someone. This was now in line with the national average of 80%.
• Patients commented that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice now had a website and Information about services and how to complain was available, easy to understand and available in other languages. 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.
• A clear leadership structure was now in place and staff felt supported by management.
• An active patient participation group had been established and 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:-

• Address areas of lower than average patient satisfaction with opening hours and the ability to get an appointment.

The areas where the provider should make improvement are:

• Identify the number of carers registered with the practice so that measures can be taken to ensure they receive appropriate support.
• Ensure practice performance continues to improve in areas that have been identified as falling below the national and local averages. For example, improving outcomes for people with diabetes and severe and enduring mental health problems,
• Put measures in place to increase the uptake of national screening programmes including cervical screening and screening for breast and bowel cancer.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 of this practice on 11 February 2016. Breaches of legal requirements were found in relation to the safe management of medicines, staff training and infection control. We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in the warning notice by 29 April 2016. We undertook this focused inspection on 12 May 2016 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.

Our key findings across the areas we inspected for this focused inspection were as follows:-

• Effective arrangements were in place to ensure medicines were stored at the correct temperature
• The practice had systems to monitor the prescribing of high risk medicines.
• Prescribing patterns had been reviewed with the clinical commissioning group and the practice had implemented an action plan
• Robust arrangements were in place for undertaking medication reviews with patients when the authorised number of repeat prescriptions had been passed.
• Concerns relating to infection control had been addressed
• Staff had received up to date training on chaperoning, infection control and basic life support

The areas where the provider must make improvements are:-

• Store prescription pads securely at all times and track their use through the practice.

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 Broadway Surgery on 11 February 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example there was no evidence that appropriate recruitment checks on staff had been undertaken prior to their employment.

• Effective arrangements for managing medicines, including emergency drugs, vaccines and high risk medicines were not in place.

• Not all staff were clear about how to report incidents, near misses and concerns.

• Not all staff who acted as chaperones had received training for the role. Also there was no evidence to show that all staff had received up to date training on basic life support.

• Not all staff who acted as chaperones had received a Disclosure and Barring Service check (DBS check).

• Staff had not received any training on infection control.

• The practice was unable to demonstrate effective management of complaints since 2014.

• The practice had not undertaken any audits of clinical practice to ensure improved outcomes for patients. There was no evidence of any quality improvement.

• There was a large variation in practice performance against the quality and outcomes framework (QOF) and national prescribing indicators compared to the clinical commissioning group (CCG) and national averages.

• Immunisation rates were relatively low for all standard childhood immunisations.

• Patients’ views were mixed. Patients told us that staff were helpful, caring and considerate. They commented that they felt listened to and well supported by their GP. However, the national survey showed that the number of patients who would recommend their surgery was significantly less than the national and CCG average.

• There was no evidence that feedback from patients including the national survey or the friends and family test had been analysed and reviewed.

• The practice had insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Ensure that action is taken to address identified concerns with medicines management and infection control.

• Ensure recruitment arrangements include all necessary employment checks are undertaken for all staff.

• Put systems in place to ensure action is taken to effectively manage the care and treatment of patients with long term conditions.

• Carry out complete clinical audits cycles to ensure quality improvements have been achieved.

• Ensure that concerns raised in feedback from staff and patients are addressed including lower levels of satisfaction in relation to the ability to get an appointment and patients overall experience of the practice.

• Address areas of low performance against the quality and outcomes framework.

• Improve the uptake of cervical screening and childhood immunisations.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision including the quality of the experience of patients in receiving those services.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which reflect the requirements of the practice.

• Ensure there is leadership capacity to deliver all improvements.

• Ensure all staff who undertake chaperone duties receive appropriate training.

• Ensure all staff have up to date basic life support training.

• Ensure that there are sufficient numbers of suitably qualified staff, particularly in relation to practice nursing staff.

The areas where the provider should make improvement are:

• Ensure accurate training records are kept including the level of safeguarding training attained by GPs and induction checklists

• Ensure written information about services is provided in other languages.

• Ensure the practice is able to demonstrate effective management of complaints.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give patients who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice