A Cambridgeshire GP practice has been placed into ‘special measures’ after inspectors raised concerns around ‘non-clinicians’ and nurses without prescribing qualifications completing medicine reviews.
The Care Quality Commission (CQC) has downgraded Parson Drove Surgery from ‘good’ to ‘inadequate’ following an inspection in January.
Inspectors said the practice could not demonstrate how it assured the ‘competence’ of staff employed in advanced clinical practice, including nurses, paramedics, pharmacists and physician associates.
In an evidence report published this month, the CQC said it identified ‘a risk to service users’ where nurses and non-clinical staff with no prescribing qualifications were completing medicine reviews.
‘The practice had not been aware of this until our inspection. This demonstrated the provider was not overseeing safe prescribing from their staff,’ the report said.
It added: ‘We also noted the absence of a protocol in place to ensure that only staff who were qualified prescribers completed medicine reviews.’
Many of the medicine reviews and other required patient reviews found at the practice were incomplete, missing, or not finished in line with national expectations or guidance, the CQC noted.
‘For example, only 5% of the practice patients on a repeat prescription had had a medicines review completed within the last 12 months. This was a significant risk to patients and we asked the provider to immediately address,’ it added.
Nurses and other health professionals can qualify to become non-medical prescribers. While having a non-medical prescribing qualification is not mandated for nurses carrying out medicine reviews, it is considered best practice.
Among other concerns raised by the CQC was that practice nursing staff ‘did not have full access to the national screening central database’.
‘This meant they could only search by a person and were unable to create a list and safely monitor all screening results,’ it said.
‘We asked the provider to implement a list to provide a register system to ensure all service users were safely followed up.’
At the time of inspection, the CQC said there was ‘no formal protocol or policy for cervical cancer screening and the provider did not keep a formal list of all samples taken’ and the percentage of those eligible for screening who had been adequately screened was below the national target by around 8%.
The CQC recognised that following the inspection, ‘the practice implemented a protocol to monitor cervical screening’.
Remote clinical searches carried out by the CQC also found a backlog of 2,500 clinical and administrative tasks, with the oldest dating back to 2017.
The CQC acknowledged that the practice provider had produced a detailed plan of how the surgery would implement a ‘daily ongoing reduction plan’ to amend the backlog.
Stuart Dunn, CQC deputy director of operations in the east of England, said: ‘When we inspected Parson Drove Surgery, we were concerned that leaders weren’t managing numerous risks to people’s safety and weren’t making effective improvements when people raised issues.’
He added that practice leaders ‘weren’t providing professional supervision to staff and hadn’t ensured they had completed essential training to keep people safe’.
‘For example, we saw that some people’s medicines were being prescribed by staff without the qualifications to do so,’ added Mr Dunn.
He said: ‘We’ve told the surgery exactly where improvements need to be made and leaders have begun acting on this.
‘We’ll be monitoring the surgery closely to make sure these are carried out promptly and people are being kept safe while that happens.
‘We’ve also taken further regulatory action to protect people and will report on this when we’re legally able to do so.’
As well the practice’s rating dropping overall, it has also dropped from ‘good’ to ‘inadequate’ for safe, effective, and well-led. And it has dropped from ‘good’ to ‘requires improvement’ for caring and responsive.
The practice said it has recently appointed a new practice manager and has worked with NHS Cambridgeshire and Peterborough Integrated Care Board to organise next steps.
It has also put in place a ‘special measures plan that will help us drive positive improvements’.
The plan includes the implementation of ‘robust systems for supervision and training’ to ensure the ‘right protocols’ around medicine prescribing are being followed.
Practice manager at Parson Drove Surgery, Sabrina Khan, said: ‘We take the concerns raised by the CQC incredibly seriously.
‘The safety and wellbeing of our patients is our top priority and we have taken immediate action to put in place robust plans to make the necessary improvements.
‘We have already taken steps to enhance our safeguarding protocols and have completed the necessary risk assessments.’
