Lack of awareness among nurses about legislation on whether a patient is able to consent to treatment, as well as insufficient recruitment checks on new staff, are among issues exposed at GP surgeries by regulators.
The Care Quality Commission yesterday published a further 50 reports on the quality of care provided by GP practices in different parts of the country, as part of its rolling inspection programme.
It said it had ordered a handful of practices to ensure all staff were trained to understand the Mental Capacity Act 2005, after inspectors found some workers were not aware of it.
The legislation allows healthcare professionals to make decisions about care on behalf of patients, but only if it has been proven that patients are unable to do so.
At Forest End Medical Centre in Bracknell, while GPs knew of the act, not all nurses were aware of it or understood its core parts, said the CQC.
“Some nurses we spoke with did not understand the key parts of the legislation and were not sure how to implement it”
In its report on the practice, the CQC said: “Some nurses we spoke with did not understand the key parts of the legislation and were not sure how to implement it in their practice.
“There was no protocol on the Mental Capacity Act for staff to refer to in order to follow the principles of the act.”
Similarly, at the Waterfield Practice in Bracknell, the regulator found some nurses and GPs did not understand when they should be using the act or the principles underlying it.
Staff at the Binfield Surgery, also in Bracknell, were “not certain” whether they had received any training on the Mental Capacity Act, and there were no certificates available to suggest they had, said inspectors.
At the same practice, less than half of patients responding to a recent national survey reported that nurses were caring, noted the CQC. Inspectors were told by its manager that nurses were struggling to deal with an increasing patient caseload.
“Where we have required improvement, we will expect the practice to take the necessary steps to address the issue, and we will return at a later date”
Meanwhile, the regulator also discovered that three nurses who had been assessed as needing Disclosure and Barring Service checks – which decide whether staff are safe to work with children based on their criminal record – had failed to apply for them.
Other practices failing to carry out basic staff checks included the Mariso Medical Practice in Lincolnshire, which provided no evidence that clinicians were registered with professional bodies or that references had been obtained upon hiring them.
The Shrubbery Surgery in Gravesend was also unable to protect patients from “the risks associated with the recruitment of staff who may be unfit or unsuitable for their role” after the regulator found the practice did not hold employment history checks, references, and photographic identification for all its staff.
Despite the CQC’s assessment that these practices and two others required improvement in its latest inspections, it found more than 40 other GP surgeries were providing “good” or “outstanding” services.
The reports published yesterday are from the regulator’s second round of GP inspections. Findings from the first batch were published in November.
Nigel Sparrow, the CQC’s senior national GP advisor, 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 that is what we find on inspection we give it a rating of ‘good’, and I congratulate the GPs and staff in these practices,” he said.
“Patients should be able to expect high quality and consistent care from every GP practice. Where we have required improvement, we will expect the practice to take the necessary steps to address the issue, and we will return at a later date to check that those improvements have been made,” he added.