Inspectors reveal examples of serious failings at primary care facilities

Gloves and dressings that had passed their sell-by dates, broken clinical waste bins, cramped reception areas and old carpets that presented a trip hazard were all noted during Care Quality Commission (CQC)inspections of primary care buildings across England.

From 1 April 2013 all providers of NHS general practice and other primary medical services must be registered with the CQC. To gain approval they must meet a series of standards.

And as BBH revealed earlier this week (click here for the article), some providers have been warned they could face closure unless they improve their facilities and the service they provide to patients.

Now the CQC has published case studies providing examples of what non-compliance with the regulations looks like in different settings, and the different levels of impact that can have on people.

In terms of the buildings from which services are delivered, inspectors found a number of issues that would lead to breaches of the Safety and Suitability of Premises standard.

The provider was not ensuring that people were protected against identifiable risks of acquiring a healthcare associated infection. This was because the provider did not have effective systems in place to assess the risk of and to prevent, detect and control the spread of such an infection

At one practice fire doors were wedged open, despite this being noted in an earlier security risk assessment. Combination locks fitted to the medical supplies and staff rooms were also left unlocked.

The inspectors noted: “People were not protected from the risks associated with unsafe premises. This was because the provider had not taken appropriate measures in relation to the security of the premises and fire doors operating properly.”

At another property a small open-plan waiting room did not have sufficient seating for people waiting to be seen at busy times. This meant patients often had to stand in the entrance hall. Not only did this mean the waiting room could not be properly observed so staff could spot a deteriorating patient, but carpets in that hallway were also seen to be ripped, creating a trip hazard.

In the worst example inspectors found, rising damp was identified in treatment rooms, including one used for minor surgery. Rodent traps were found in the staff kitchen and an electrical junction in the reception area had not been boxed off. The practice had no plans in place to address these problems.

Infection control breaches were also discovered at a number of practices.

Problems included lapses in regular infection control audits and infection prevention and control leads with no specific recent training in relevant practices.

At one practice neither of the two foot-operated clinical waste bins worked properly in treatment rooms and there were broken tiles above a basin. A couch used for minor surgery also had tears in vinyl covering.

The inspectors said: “People were not cared for in a clean and hygienic environment. The provider was not ensuring that people were protected against identifiable risks of acquiring a healthcare associated infection. This was because the provider did not have effective systems in place to assess the risk of and to prevent, detect and control the spread of such an infection.”

In one of the worst cases, dressings and gloves used to prevent the spread of infection during and following treatment were found to be past their expiry date. The antibacterial scrub used to clean hands and kill bacteria had also expired in 2009. On continuing their inspection, the team found that one of the treatment rooms did not have a proper clinical waste bin and there were dust and cobwebs in areas where treatment would be taking place.

These case studies provide indicative examples of what non-compliance and the impact of non-compliance look like for each of the essential standards in NHS GP practices and other primary medical services

In other standard areas, emergency treatment kits were found to be lacking equipment or medicines had expired. This included life-saving intravenous drugs and anaphylactic shock kits.

In terms of the service provided to patients, some patients complained their GPs did not explain their treatment or medication to them. In one practice the GP admitted he ‘did not have time’ to explain the implications of treatment and had told a patient to ‘look it up on the web’.

A spokesman for the CQC said: “These case studies provide indicative examples of what non-compliance and the impact of non-compliance look like for each of the essential standards in NHS GP practices and other primary medical services. This includes GP practices, GP out-of-hours services and walk-in centres. These providers were registered by 1 April 2013 and the CQC is now inspecting them to check their compliance with the essential standards of quality and safety.

When we inspect, we judge whether a provider is compliant or non-compliant by using our judgement framework. This then determines the appropriate compliance or enforcement action we will take when there is non-compliance, as set out in our enforcement policy.

In the BBH article published earlier this week, we revealed that 20% of GP practices faced problems with compliancy, particularly in relation to the standard of premises and infection control issues.

Click here to read more case studies.