Archived: The Hollies Surgery

Letter from the Chief Inspector of General Practice

We first carried out a comprehensive inspection at The Hollies Surgery on 28 January 2016 where the practice received a rating of requires improvement overall. The practice received requires improvement for providing safe, effective and well-led services and good for providing caring and responsive services. As a result the practice was issued with a requirement notice for improvement.

We then carried out a further focused inspection on 1 September 2016 to follow up on improvements and found that suitable improvements had not been made. The practice remained at requires improvement overall. The practice was rated as requires improvement for providing safe and effective services and inadequate for providing well-led services. As a result the practice was issued a warning notice and were to be compliant by March 2017.

A focused follow up inspection was carried out on 7 March 2017 to review the issues highlighted within the warning notice and we found that the practice had made the necessary improvements and were found to be compliant. As a result we carried out our most recent inspection on 4 May 2017 to follow up on areas of improvement and conduct a ratings review.

The full reports for the January 2016, September 2016 and March 2017 inspections can be found by selecting the ‘all reports’ link for The Hollies Surgery on our website at www.cqc.org.uk.

At our 4 May 2017 comprehensive inspection we found improvements had been made, overall the practice is now rated as good.

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

• There was an effective system in place for reporting and recording significant events. Staff confirmed discussions had been held and lessons learnt. We found evidence to demonstrate how learning had been shared and changes embedded into practice.

• Patient safety and medicine alerts had been appropriately responded to.

• 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.

• We found the practice had developed multiple quality improvement processes to monitor their medicines however, we found one area relating to patients being treated for thyroid conditions where appropriate reviews had not been undertaken.

• All staff had received a Disclosure and Barring Service (DBS) check and an appraisal within the last 12 months.

• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

• We found that staff had a clear understanding of key issues such as safeguarding, Mental Capacity Act and consent.

• All practice policies and protocols were practice specific, updated and reviewed.

• The practice had identified 172 patients as a carer which was 1.2% of their patient list.

• Information about how to complain was available and easy to understand. Complaints were responded to at the time of reporting where possible. Learning from complaints was shared with staff.

• The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

• The practice worked closely with their clinical commissioning group (CCG) to provide essential primary care to vulnerable adults within a domiciliary setting.

• The practice proactively sought and valued feedback from staff and patients, which it acted on. The patient participation group was active.

• There was a clear leadership structure and staff felt supported by management. The practice held regular staff, clinical and partner meetings.

• The practice had reviewed their national GP survey results and were implementing action plans to address the appointment availability issues that were raised.

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

Actions the provider SHOULD take to improve:

Improve the system for reviewing patients taking prescribed thyroid medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 28 January 2016, we carried out a comprehensive announced inspection. We rated the practice as requires improvement overall. The practice was rated as requires improvement for providing safe, effective and well-led services. The practice was then re-inspected on 01 September 2016 and we found that sufficient improvement had not been made. Therefore the overall rating remained as requires improvement. A rating of requires improvement for providing safe and effective services and an inadequate rating for well-led was given. The practice was rated as good for providing caring and responsive services.

As a result of this inspection and due to repeat issues from the previous inspection, a warning notice was issued to the practice. The previous reports can be found by selecting the ‘all reports’ link for The Hollies Surgery on our website at www.cqc.org.uk.

The practice was required to be compliant with the warning notice by February 2017. We conducted a focused inspection on 07 March 2017 to establish whether they were complaint with the warning notice.

We previously found that:

• The provider did not have effective systems or processes to assess, monitor and mitigate the risks to the health, safety and welfare of patients, particularly in relation to patients at risk of stroke. The system of audit was ineffective in identifying and managing risks to patients.
• Staff were acting in a clinical role without relevant risk assessments or disclosure and barring service checks in place.
• Policies were incomplete or not being adhered to, including those relating to needle stick injury and Health and Safety.
• There were limited opportunities for non-clinical staff to give their feedback to identify where improvements to services may be required. Non-clinical staff were not routinely invited to practice meetings.
• Non-clinical staff did not all receive regular appraisal.

The practice was required to be compliant with the warning notice by March 2017. At our focused inspection on 07 March 2017 we found;

• The system of audits was effective for assessing and monitoring patients at risk of stroke.
• There were procedures in place for monitoring and managing risks to patient and staff safety. There was a health and safety policy available with a poster in reception, which identified local health and safety representatives.
• The practice has mitigated previous risks by ensuring all clinical staff members had received a Disclosure and Barring Service (DBS) check.
• The learning needs of all staff were identified through a system of appraisals, meetings and reviews of practice development needs.
• Weekly practice meetings were held and open to all staff members. These meetings had several standing items on the agenda. Staff told us there was an open culture within the practice and they had the opportunity to raise any issues at team meetings and felt confident and supported in doing so.
• The practice presented us with 13 audits, two of which were clinical audits which related to medicine management. The audits were aligned to national guidance, performance had been assessed, and learning was evident with improved clinical outcomes.

The practice had complied with the warning notice. However, the practice will remain rated as requires improvement until a further inspection in 2017 has been undertaken.

Action the service SHOULD take to improve:

Improve the monitoring of blood pressure in relation to patients suffering from hypertension and those with diabetes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice