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Nurses criticised at GP practices placed into 'special measures'

  • 19 Comments

A group of GP practices have been placed into special measures after inspectors raised concerns, including a lack of staff learning following safety incidents, failure by nurses to understand mental capacity legislation and outdated training on vaccinations.

As part of its inspections of general practice, the Care Quality Commission released reports on a further 61 GP services in England last week.

The reports reveal that four – Constable Country Rural Medical Practice in Ipswich, New Inn Surgery in Guildford, Dr Alan Samuel Muir Grasse in north London and Polkyth Surgery in Cornwall – have been rated as “inadequate” and put into special measures, which means they must improve or risk losing their registration.

“Evidence of effective dissemination of safety issues or shared learning amongst the team was inadequate”

CQC report

At Constable County Rural Medical Practice, inspectors were told by nurses they had not had a team meeting in more than a year.

In its report on the practice, the CQC noted that “evidence of effective dissemination of safety issues or shared learning amongst the team was inadequate”.

The report also highlighted difficulties with the availability of the nursing team at both the main practice and the branch surgery.

“We were told [a healthcare assistant] was not receiving any clinical supervision appropriate to the work they were being expected to perform”

CQC report

It noted an incident in which there were no nurses available at the practice to perform dressings on two occasions, which resulted in a patient having to go to A&E both times following minor injuries.

Inspectors found healthcare assistants did not feel supported. They were told of one incident where a member of staff working unsupervised “had acted in desperation in making decisions regarding treatment for a patient”.

“We were told they were not receiving any clinical supervision or support appropriate to the work they were being expected to perform,” added the CQC report.

The regulator also found nurses lacked confidence to use the Mental Capacity Act 2005, which allows healthcare professionals to make decisions about care on behalf of patients, if it has been proven that patients are unable to do so.

This was a problem also highlighted at New Inn Surgery in Guildford, where one of the GPs, the nurse and other staff were all unfamiliar with the mental capacity legislation.

“Nursing staff must receive up to date training in vaccinating adults and children”

CQC report

At this surgery, the CQC also noted in its report that the practice nurse was the lead for infection control, but that an infection control audit had not taken place and there was not policy on this area for staff to refer to.

Meanwhile, Polkyth Surgery in Cornwall has been told “nursing staff must receive up to date training in vaccinating adults and children” after inspectors found staff some staff required updated training.

A gap in understanding among nurses about who to report abuse to was also identified by inspectors.

However, the regulator did find that nurses at this practice had a “sound knowledge” of the Mental Capacity Act 2005 and its relevance to their practice, “despite a lack of recent training or updates”.

“The patients talked highly of, and gave praise, to the practice nurses. They also told us they felt listened to and supported by the nursing staff,” added inspectors.

“If we find a practice to be inadequate, we will normally put it into special measures, to allow the practice to access support available from NHS England”

Steve Field

At the Dr Alan Samuel Muir Grasse surgery, the regulator found no practice nurse was employed, which it said contributed to services not meeting the needs of the patient.

“We were advised that patients requiring a cervical smear test or baby clinic were referred to a local health centre. We noted that this was potentially discriminatory towards women and parents,” noted inspectors in their report.

Professor Steve Field, chief inspector of general practice, said: “We know that the vast majority of England’s GPs are providing a service which is safe, effective, caring, responsive and well led.

“If we find a practice to be inadequate, we will normally put it into special measures, to allow the practice to access support available from NHS England and to ensure there is coordinated response to help the practice improve.”

  • 19 Comments

Readers' comments (19)

  • I just returned from a cruise ship the Oceana.one evening at a quiz two questions came up:-
    What are the 4 common blood groups, and, what is the body's normal body's temperature, in centigrade.
    I was chuffed to bits and told my team the answers.
    The quiz person read out her answers from her check list.
    First answer... The four common blood groups are... Minus A, minus B, minus AB and minus O.
    Next answer, the body's normal temperature is...36 degrees centigrade.
    My answers were marked a wrong?


    I had been working as a charge nurse/ clinical nurse manager four over 30 years. My answers were A B. AB and O, and, 37 degrees Centigrade.
    I've checked my answers out with around 20 other people , including some who have worked as nurses in the NHS, none of them knew the answers, or could confirm whether the quiz answers were correct or not.
    OMG!
    Yes, 'nurses definitely need to update their knowledge and skills if they should continue to work as nurse professionals.
    Incidently, does anyone out there know the answers to the question. Wikepedea wasn't much help, and all my old nursing books give the same answers as I did.

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  • why is it always nurses that get blamed for everything

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  • Because they are directly in touch with 'the patient', who assumes they will be cared for. When it all goes 'pear shaped' the patient criticises the 'nurse'.

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  • michael stone

    I'm not at all surprised about the issue with understanding of, and application of, the Mental Capacity Act.

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  • I worked for 17 years as a practice nurse. It was virtually impossible to get time and money out of the GPS to go on study/training days. Even then I was only allowed to go if it was relevant to my work. I had to find my own replacement for study and holidays as I was a single handed pn. Until gp's are employed by the NHS and not a private business a lot of them will never change.

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  • Michael Stone:

    "I'm not at all surprised about the issue with understanding of, and application of, the Mental Capacity Act."

    I agree Mike, I spend half my working day trying to promote the MCA.

    Mind you, it doesn't help that the NT have said the act:

    "allows healthcare professionals to make decisions about care on behalf of patients, if it has been proven that patients are unable to do so."

    Whilst that is, of course, true it is neither the purpose of the act or its main focus, which is on supporting and enabling patients to make their own decisions.



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  • need to employ more nurses then, cant see anyone wanting to queue up for these jobs anytime soon

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  • having read the information, it appears it is not surprising nurses arwent understanding it, it is very complicated

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  • Ima Cynic, my understanding of blood groups is are the 4 you stated which are correct based on the ABO system, but as you probably know as well blood is grouped by the RhD system which is a positive or negative dependant on whether the D antigen is present on surface of RBC's. Also to give an exact temperature of as normal is also incorrect, and normal is better expressed as a range ie 36.1-37.9 degrees centigrade. This also is variable because is depends on whether that is a direct core ,an axillary measurement or tympanic measurement. So really it depends on what level of knowledge you need for the situation. Ie. doing your job and keeping patients safe in an evidence based best practice scenario or what you tell a five year old child for a biology test. Hope that helps.

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  • Michael Stone

    'End of Life Journal'

    http://eolj.bmj.com/site/about/


    have just come across this journal from St. Christopher's Hospice which might have articles of interest to you if you are not already familiar with it. it seems to be your area of interest.

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