11 December 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Tollerton Surgery on 7 June 2017. The overall rating for the practice was good but the safe key question was rated as requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Tollerton Surgery on our website at www.cqc.org.uk.
This inspection was an unannounced focused inspection carried out on 11 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is now rated as good.
Our key findings were as follows:
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The practice dispensed medicines for patients on the practice list who did not live near a pharmacy.The practice had standard operating procedures (SOPs) which were regularly reviewed and covered all aspects of the dispensing process (these are written instructions about how to safely dispense medicines). A system was in place to ensure relevant staff had read and understood the SOPs.
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The practice held stocks of controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse), and had SOPs in place covering all aspects of their management. Controlled drugs were stored in a controlled drugs cupboard, access to them was restricted and the keys were held securely. Previously, full balance checks of controlled drugs had not been recorded. We found staff had carried out regular checks and recorded them on the electronic document management system.
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Expired and unwanted medicines were disposed of in accordance with waste regulations.
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We found a new SOP had been introduced to guide staff how to handle uncollected prescriptions. Appropriate arrangements were now in place for the regular checking of uncollected prescriptions. Checks also included ensuring all prescriptions awaiting collection were signed by an appropriate prescriber, however some unsigned prescriptions had not been picked up by the checks.
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A new checking process had been introduced to ensure Patient Group Directions remained legally valid and fit for use.
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A “near miss” record (a record of errors that have been identified before medicines have left the dispensary) was in place, allowing the practice to identify trends and patterns in errors and take action to prevent reoccurrence.
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There were arrangements in place for the recording of significant events involving medicines.
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A new system had been introduced to track the use of blank prescriptions since our last inspection. However, the system of recording was not fit for purpose, and staff could not accurately account for the prescriptions on the premises on the day of our visit.
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The practice had increased the number of identified carers from 0.7% to just over 1%.
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Infection control issues identified at the last infection had been addressed.
However, there were also areas of practice where the provider needs to make improvements.
The provider should:
Review the checking process for prescriptions awaiting collection, in particular to ensure they are signed by an appropriate practitioner
Review the system for recording and tracking blank prescription forms
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice