Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Al-Shafa Medical Centre on 18 January 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events. Information about safety was recorded, monitored and reviewed and the results shared with staff including lessons learned.
• Risks to patients were assessed and well managed. These included staff recruitment procedures, health and safety systems and ensuring sufficient staffing levels were in place to meet patient needs. There was adequate medical equipment and medicines available if a patient presented with a medical emergency.
• Clinical staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received role appropriate training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patient feedback demonstrated that patients were treated with compassion, dignity and respect. However, the National GP Patient Survey data showed that patients consistently rated the services below national averages. Action was being taken to address the results.
• Information about services and how to complain was available and easy to understand. Where necessary improvements were made to the quality of care as a result of complaints and concerns.
• Some patients told us they found it difficult to make a pre-booked appointment. All urgent appointment requests were accommodated the same day.
• There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

• A GP partner provided a one stop non-invasive community cardiology (heart) service for diagnosing heart conditions. This included a range of tests such as, electrocardiography (ECG), 24 hour blood pressure monitoring and echogram (scan) and others. This meant that patients required fewer visits to the hospital for tests.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Continue to identify and support carers.

• Make patients aware of the services available including health screening and extended opening hours.

• Find a way of addressing clarity about patient access and patients’ perceptions of access and the services they receive.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

In order to target our inspections effectively we continually gather information about services. This may include information from health professionals and other staff; people who use services and family members. We had received information which led us to review circumcision procedures at a number of GP practices. In order to do this CQC inspectors were accompanied by a specialist advisor in urology.

The visit to the practice was unannounced; this meant that the provider and staff at the practice did not know we were coming.

Al-Shafa Medical Centre had recently applied to CQC to include surgical procedures in their registration. Plans were in place to introduce a circumcision service; however at the time of the inspection they were not performing any surgical procedures.

We looked at the systems being developed in preparation for the commencement of surgical procedures. We saw that policies and processes were being implemented. Work had commenced on the documentation required for obtaining consent from patients.

Quality monitoring systems had been considered with the development of audit tools and questionnaires.

During our inspection we spoke with eight patients who used the service. Two of the patients were also members of the Patient Participation Group. We also spoke with eight members of staff, including two GPs and the practice manager.

Most patients we spoke with were very positive about the care and treatment they received, all but one patient told us that they would recommend the practice to others. Patients told us that they were treated with dignity and respect and that they felt safe using the service. Comments received from patients about the service included, “It’s good, I got breast cancer, the doctor called me out of hours to talk to me to tell me he was here if I needed help” and “It’s as good as any other practice in the area.”

We found people were protected from the risks associated with medicines. Most patients on long term medication told us that they were satisfied with the way their medicines were managed and that their medicines were kept under regular review.

There were systems in place to manage complaints received about the practice. We saw that patients were supported to feedback their comments and complaints and that they were acted on.