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a lack of staff learning following safety incidents, failure by nurses to understand mental capacity legislation and outdated training on vaccinations.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”
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”
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”
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”
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.”