Cumberland House

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Cumberland House on 6 April 2017. The overall rating for the practice was good with requires improvement in providing a well led service. The practice was served a Requirement Notice in Regulation 17 Health and Social Care Act (Regulated Activity) Regulations 2014, Good Governance. The full comprehensive report from 6 April 2017 inspection can be found by selecting the ‘all reports’ link for Cumberland House on our website at www.cqc.org.uk.

This inspection was an announced focussed follow up inspection carried out on 5 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation identified in our previous inspection on 6 April 2017. This report covers our findings in relation to those requirements.

We found these arrangements had significantly improved when we undertook a focussed follow up inspection on 5 October 2017. The practice is now rated as good for being well-led.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had introduced a National Institute for Health and Care Excellence (NICE) guidelines agenda item into their clinical governance and information meeting in September 2017. Although this approach had only recently commenced and therefore did not demonstrate an embedded system, there was oversight in place to demonstrate that NICE guidelines were implemented through risk assessments, audits and searches of patient records.

• An electronic system to enable clear audit, monitoring and work load assessment including emergency appointments and triage calls had been implemented.

• One of the GP partners together with an administration prescribing support staff member had developed systems and processes to ensure the practice were in receipt of and actioned all appropriate patient safety and medicine alerts.

• The practice manager had implemented a system to ensure that staff providing care and treatment had received Disclosure and Barring Service (DBS) checks or that a risk assessment was in place if this was considered not to be required.

• We found that suitable notices of the chaperone service available to patients were available in the main site. The practice assured us that these were all posted at the branch location where a chaperone service was also made available to patients.

• The practice had taken prompt action to ensure they maintained staff’s full immunity record not just their Hepatitis B status.

• The GPs at the practice had considered what medicines were appropriate to be held in their bags. The practice manager had implemented a checklist to enable clear monitoring and oversight of these medicines, including for example the name of the medicine, quantity and expiry date.

• Clinical staff had been in receipt of training in the Mental Capacity Act and Deprivation of Liberty safeguards in 2017.

• The practice demonstrated they had continued to improve the identification of patients who were carers and provide them with appropriate support.

However, there were also areas of practice where the provider needs to make improvements the provider should:

• Subsequent to staff changes update the safeguarding policy with the name of the new safeguarding lead at the practice, a review date and content to include for example, modern slavery.

• Document the clinical supervision provided to clinical staff at 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 Cumberland House on 9 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the on 9 May 2016 inspection can be found by selecting the ‘all reports’ link for Cumberland House on our website at www.cqc.org.uk

We undertook an announced comprehensive follow up inspection on 6 April 2017 to check that improvements had been made. Overall the practice is now rated as good with requires improvement in well led.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. However, this was not embedded.There were proposed changes to the partnership organisational structure with newly recruited staff and a focus on a new strategy to deliver their vision, which had been produced with stakeholders. These changes had been reviewed and discussed with staff, NHS England, the local CCG and the patient participation group.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• Governance improvements were required in areas such as; NICE guidelines, the receipt of medicine alerts, workload assessment of emergency appointments, staff training in the Mental Capacity Act and Deprivation of Liberty safeguardsand Disclosure and Barring (DBS) checks.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure there is a system and oversight in place to demonstrate that NICE guidelines are implemented through risk assessments, audits and searches of patient records.
• Additional emergency appointments and triage calls require the implementation of an effective system to enable clear audit, monitoring and work load assessment.
• Ensure the practice are in receipt of all appropriate patient safety and medicine alerts and take appropriate action.
• Ensure that staff providing care and treatment have received DBS checks or that a risk assessment is in place if this is considered not to be required.

In addition the provider should:

• Provide suitable notices of the chaperone service available to patients and ensure a chaperone service is readily available at both the branch and main site locations.

• Maintain staffs full immunity record not just their Hepatitis B status.

• Consider a documented rationale as to what medicines GPs hold in their bags and a checklist to enable clear monitoring and oversight.

• Implement clinical staff training in the Mental Capacity Act and Deprivation of Liberty safeguards.

• Continue to improve the identification of patients who are carers and provide them with appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice