Pudding Pie Lane Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mendip Vale Medical Practice and its four branch sites on 15th, 16th and 17th August 2017. 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 reporting and recording significant events.
• The practice had systems to minimise risks to patient safety. However, these were not used consistently or embedded across the provider locations.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Relationships with care services and the support given to patients living in these care services had improved during the last six months.
• Information about services and how to complain was available. Some improvements were made to the quality of care as a result of complaints and concerns. However, there was an inconsistent approach to identifying trends, themes and responding to concerns raised.
• Patients we spoke with 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 at two of the locations, and had contingency plans to improve these for patients who used the Congresbury, Yatton and Wrington. All the locations were well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was not always aware of the requirements of the duty of candour as there was an inconsistent approach to managing complaints and significant events investigations.

• The practice had not investigated under their Significant Events Analysis, complaints processes, or responded to under the Duty of Candour an event where a patient received a serious injury on the practice premises. The practice had not informed the CQC in a timely way via a Statutory Notification form of an event that was reported under RIDDOR( Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995) in April 2017.

The areas where the provider must make improvements are:

• The registered persons had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment. In particular, ensuring that appropriate Disclosure and Barring Service checks and training were in place for those staff carrying out chaperone duties.

• There was limited proper and safe management of medicines. In particular, stock medicines and the management of controlled and emergency medicines.

• There were no systems or processes that ensured the registered person maintained securely such records as are necessary to be kept in relation to the management of the regulated activity or activities. In particular, the management of prescription paper, prescription pads their security and ensuring there was a clear audit trail maintained.

• The registered person had systems or processes in place that operated ineffectively in that they failed to assess, monitor and improve the quality and safety of the services being provided. In particular, ensuring staff worked in accordance to policies relating to significant event analysis, emergency medicines, complaints, medicines management and health and safety.

• The practice had not investigated under their Significant Events Analysis, complaints processes, or responded to under the Duty of Candour an event where a patient received an injury on the practice premises.

In addition the provider should:

• Have infection prevention and control, hand washing and aseptic technique audits in place and have oversight of the immunisation status of all staff.

• Review the systems for holding data sheets in regard to Control of Substances Hazardous to Health kept at the practices.

• Ensure the regular fire drills are carried out for all staff at all of the locations.

• Review processes for checking emergency equipment.

• Ensure that non-clinical staff have the necessary training and guidance for the triage of patient’s needs in regard to the urgency of being seen by a clinician.

• The provider should notify the commission without delay any incidents of serious injury to a service user (patient), such as a fall on the premises, which occurs whilst services are being provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice