Archived: Lynton Health Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Lynton Health Centre on 2 August 2016. Overall the practice is rated as requires improvement.

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

• Forty one patients gave feedback at the inspection. Their comments were consistently positive and said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.However, we found some gaps in the recruitment practices for checking staff before employment. The practice did not have appropriate systems in place for to meet current guidelines for cytotoxic waste. 

• 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.
• 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 experienced accessible and integrated services at Lynton Health Centre. They 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. They were able to access nurse led clinics in the minor injuries unit attached to the practice.
• The practice had purpose built 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 practice was visionary in how services were being developed for people in Lynton and the surrounding areas. The GPs were strongly focussed on an integrated model of care, empowering patients as partners in their care.

• The practice governance frameworks were not always effective in supporting the delivery of the strategy and good quality care. Whilst staff assessed patients’ needs, the practice did not have an effective risk management system with which to identify and mitigate all potential risks in a timely way.This included: Leadership and accountability for infection control measures within the practice. The practice had limited audit and a lack of assessment for both infection control and legionella risks. The practice did not have sufficient systems in place to obtain assurance from the local NHS Trust who employed nurses to give care the practice patients; about their skills, training and competencies of community nursing staff who were delivering treatment room services such as phlebotomy and wound care on behalf of the practice.

The areas where the provider must make improvement are:

• Establish and operate effective systems to assess the risk of, preventing, detecting and controlling the spread of infections, including those that are health care associated.

• Ensure recruitment arrangements include all necessary employment checks for all staff. For example, evidence of identity, references, checks of professional registers;Disclosure and Barring Service (DBS) checks or risk assessments for all staff providing a chaperone service for patients; and obtaining and retain evidence of insurance indemnity for all clinical staff, including locum GPs.

• Establish and operate effective audit and governance systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients. This is in respect of monitoring risks, reviewing and updating policies and monitoring arrangements with the local NHS Trust who employed nurses to give care to the practice patients.

Areas of should

• Review the child safeguarding procedures.

• The practice should fully utilising the electronic patient record system to ensure that any concerning information about a patient is recorded and coded accordingly for ease of searches and reduction of any associated risks.

• The practice should follow current guidelines covering the safe monitorning of vaccines for patient use by recording the minimum and maximum temperatures of any refrigerators being used.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice