The intention of sharing the content of this report is to assist practices that have not yet been inspected. They can use the summarised version of the report to identify risk areas in their own practice, creating a suitable action plan to reduce the associated risk prior to inspection.
We understand how painful and damaging a CQC inadequate report is to practice and its team. If you have been personally affected by this report please get in touch. We will offer a listening ear.
If you need more formal support we would recommend the “Looking after you team”. They offer an non-judgmental coaching support service: https://www.england.nhs.uk/supporting-our-nhs-people/support-now/looking-after-you-confidential-coaching-and-support-for-the-primary-care-workforce/looking-after-you-too/
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https://www.cqc.org.uk/location/1-542241886
We rated the practice as inadequate for providing a safe service because:
• Systems did not fully support the safeguarding of children and vulnerable adults.
• Assurances that staff employed by the Primary Care Network and working in the practice had been recruited in accordance with Regulations had not been gained.
• Systems for assessing the immunisation status of non-clinical staff were not in place.
• Risk assessments had not always been completed or shared with staff to assess and manage risks.
• Findings from the practice’s infection control and prevention audits and risk assessments had not been acted on in a timely manner. Water temperatures had not been recorded in line with the legionella risk assessment since September 2022. Sharps bins were not always dated in line with national guidance.
• Staff told us that staffing levels were not adequate to meet the demands of the service. Some staff expressed concerns that despite invites to training and support from the safeguarding lead for GoToDoc Ltd, they did not feel they had been adequately trained to carry out their lead roles in safeguarding.• Patients’ records were not always managed in line with current guidance.
• There was a backlog in the summarising of notes and, the scanning and coding of hospital discharge letters.
• A system of clinical supervision or peer review was not in place for non-clinical prescribers.
• Patients prescribed high-risk medicines or patients prescribed medicines for their long-term conditions had not always received the required monitoring.
We rated the practice as requires improvement for providing an effective service because:
• A representative of a care home expressed concern about a 2-month delay in providing their residents with flu vaccinations over the winter period.
• The system in place to offer annual reviews to check the health and medicine needs for patients was not always effective.
• Systems for following up on patients with undiagnosed diabetes were not always effective.
• Patients with long-term conditions were not always reviewed to ensure their treatment was optimised in line with national guidance.
• We found over 200 hospital letters waiting to be scanned and coded on the day of our onsite inspection.
• Some staff told us they did not feel they had received adequate training during their induction to carry out their roles and that the training had been rushed. Staff expressed concerns about who would support and train new staff due to the loss of experienced staff.
• Formal clinical supervision was not in place to support staff working in advanced roles. Oversight and supervision of long-term locum GPs was carried out mostly remotely.
We rated the practice as good for providing a caring service because:
• Staff treated patients with kindness, respect and compassion and helped patients to be involved in decisions about care and treatment.
We rated the practice as requires improvement for providing a responsive service because:
• Patients did not always receive the care they needed within a timely manner including flu immunisations for patients living in a care home.
• The provider had not acted in line with their own complaints policy and informed patients they could take their complaint to the Parliamentary and Health Service Ombudsman (PHSO) if they were unhappy with the outcome of the investigation of their complaint.
We rated the practice as inadequate for providing a well-led service because:
• The delivery of high-quality care was not assured by the leadership, governance or culture within the practice
• Most staff told us that the provider was not visible and that they did not feel valued or listened to by the provider.
• There was a plan in place to support transformation in the practice however, the impact of the actions did not align with what staff told us or patients’ responses. This had led to an ongoing reduction in the practice’s patient list size in contrast to the other practices in Buxton.
• The provider told us there was a Freedom to Speak Up Guardian and this information had been shared with staff in various ways. However, 6 out of 7 staff members that returned CQC questionnaires to us told us they were unaware of this support meaning communication with staff had been ineffective. Some staff feared retribution for raising concerns.
• Most staff told us that staff morale was very low due to high levels of stress and work overload. Most staff told us they did not feel respected, valued, supported or listened to by the provider.
• Governance arrangements and policies were not always up to date, lacked clarity or not complied with. Some staff told us they were unsure of where to locate policies. The practice’s Business Continuity Plan had not been updated to reflect changes within the practice.
• There were a lack of systems in place to provide appropriate onsite supervision of non-medical prescribers, agency staff and locum GPs increasing risks to patients.
• Practice risk registers and action plans had been put in place however, they did not reflect all of the risks we identified as part of our inspection.
• Required statutory notifications had not been forwarded to the CQC within a timely manner.
We found 2 breaches of regulations. The provider must:
• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
In addition, the provider should:
• Take action to improve their cervical screening uptake rate which was below the national target of 80%.
• Work with care homes to improve communication and support.
• Continue to carry out improvements to manage the heating, maintenance and water temperature within the premises.