Archived: Dr John Cormack

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr John Cormack on 10 November 2016. Overall the practice is rated as requires improvement.

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

• There were insufficient systems and support for staff to identify report, investigate and learn from significant incidents.
• The practice had not consistently actioned patient safety and medicines alerts placing patients at risk.
• Not all clinical staff had undertaken safeguarding training. The practice did not follow up on children and vulnerable patients who failed to attend hospital appointments or patients who had not collected their prescriptions.

• Not all clinical staff had undertaken infection prevention control training. The practice cleaning schedules lacked detail to confirm when, where and how rooms and equipment had last been cleaned.

• Some clinical staff members had not received training in the Mental Capacity Act in relation to obtaining consent.
• The practice cold chain policy for the safe storage of medicines had not been adhered to. Staff had failed to report and investigate when the fridge temperature exceeded recommended levels.
• We found the practice nurse had administered vaccinations to children and vulnerable patients without the written direction from a GP.
• Appropriate recruitment checks had not been completed for a member of the practice clinical team.
• We found not all members of the clinical team had undertaken emergency life support training. They had access to appropriate equipment and checks were conducted and recorded.
• Emergency medicines were available and in date but some recommended medicines in relation to the services provided, were not being stored and a risk assessment had not been undertaken.
• The clinical team had access to NICE guidance and the nursing team were working within their Mid Essex formulary, shared care protocols and competency levels.
• The practice had consistently strong clinical performance in their QOF performance in 2014/2015 and 2015/2016. They achieved 97% with below the local exception rates.
• We found that patient blood results, test results and out of hours information was managed in a timely and appropriate way. Patient referrals were also found to be appropriate and demonstrated a clear understanding of local and national guidelines.
• There was evidence of appraisals and personal development plans for all staff.
• Data from the national GP patient survey showed patients rated the practice higher than others for all aspects of care.
• Patients consistently told us they received a personalised service where they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• There was a lack of quality improvement processes in place at the practice, including clinical audit.
• The practice was active within their Clinical Commissioning Group and worked with their Commissioners.
• There was a clear staff structure and staff were trusted to fulfil their roles with minimal oversight. However the system of governance in place was not identifying where some patients were at risk and there was a lack of clinical oversight and supervision of staff carrying out their duties. Meetings were irregular and not consistently recorded, including an absence of discussions and decisions.
• The practice had an active and supportive Patient Participation Group. They represented the practice and patients within the wider health forums to improve services.

The areas where the provider must make improvements are:

• Ensure there are systems and support for staff to identify, report, investigate and learn from significant incidents.
• Ensure that there is an effective system in place to action patient safety and medicine alerts.
• Ensure that the system in place to manage and act on safeguarding issues affecting children and vulnerable adults is effective.
• Ensure that authorities are obtained for the safe administration of medicines by the nurse working at the practice
• Ensure recruitment checks are undertaken for all staff in line with guidance.
• Ensure that staff are appropriately supervised and trained to carry out their roles.
• Ensure the effective assessment of risks and preventing, detecting and controlling the spread of infections.
• Maintain a recommended supply of emergency medicines for use in relation to the services provided or undertake a risk assessment as to why they are not required.
• Ensure there is an effective system of governance and clinical oversight in place at the practice including quality improvement processes.

The areas where the provider should make improvements are:

• Cleaning records should demonstrate when, where and how rooms and equipment were cleaned.

• Improvements to be made in the capturing and recording of complaints.

This service is rated as requires improvement overall. However the practice is rated as inadequate for providing safe services.  Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice