Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Asplands Medical Centre on 19 April 2016. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 – safe care and treatment.

From the inspection on 19 April 2016, the practice were told they must:

• Ensure procedures for the safe management of controlled drugs are followed and regularly reviewed.

We undertook a focused inspection at Asplands Medical Centre on 2 November 2016 to check that they had followed their plan and to confirm that they now met legal standards and requirements. This report only covers our findings in relation to those areas found to be requiring improvement. You can read the report from our last comprehensive inspection, by selecting 'all reports' link for Asplands Medical Centre on our website at www.cqc.org.uk

We found that on the 2 November 2016 the practice now had improved systems and we found the following key findings:

• Practice specific protocols and procedures had been developed to manage controlled drugs. Staff demonstrated these were followed routinely.
• Systems to ensure that appropriate stock records of controlled drugs were maintained had been implemented effectively.
• The named GP for the dispensaries conducted regular checks to ensure that procedures and protocols were being followed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Asplands Medical Centre on 19 April 2016. 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 a system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice had extended their premises to enable them to host additional services, such as a physiotherapist, a counsellor, alcohol and drug support and Alzheimer’s support services.
• The practice recognised the needs of its frail elderly population and those with complex needs and adapted its services to improve access for them. For example, operating combi clinics for patients with multiple chronic conditions and ensuring that clinics ran alongside the availability of a volunteer transport service.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• We saw that procedures relating to the management of controlled drugs were not always effectively monitored. The practice took immediate action to address this, both during and after our inspection, to ensure that protocols were followed and updated where necessary; ensuring procedures were more robust and the chance of recurrence was minimised.
• The provider was aware of and complied with the requirements of the duty of candour. We saw that the provider took prompt action to inform necessary stakeholders when concerns arose relating the management of controlled drugs.

We saw one area of outstanding practice:

• We saw that the practice had offered support to victims of human trafficking; opening outside of normal practice hours to provide this service.

There was one area where the provider must make improvement:

• To ensure procedures for the safe management of controlled drugs are followed and regularly reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as good overall. This is the third inspection of Asplands Medical Centre. At our last inspection on 8 December 2016, the practice was rated as good for providing safe services and good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Asplands Medical Centre on 21 June 2018 as part of our inspection programme.

At this inspection we found:

• The practice had sustained and continued to improve the high level of achievement since the last inspection, and had further improved in areas including caring, responsiveness and well led.
• Learning identified from our previous inspection in June 2016 had been shared with the Clinical Commissioning Group (CCG) and changes had been made to improve medicine systems in other practices.
• The practice had a highly effective and well managed quality improvement process in place to identify where they might improve. They had a continuous programme of audits and there was a cohesive practice approach to improvement. The practice performance in relation to the quality and outcome framework (QOF) was above the CCG and national average and exception reporting was below the CCG and national average.
• The strong leadership, embedded governance structure and culture were used to drive and improve the delivery of high-quality person-centred care. All staff were involved in the development of the practice and were proud of their achievements.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Staff ensured that care and treatment was delivered according to evidence- based guidelines.
• The national GP patient satisfaction data although statically comparable was consistently above the local and national averages for outcomes on the National GP Patient Survey published in July 2017. Some areas were higher than the January 2016 data. Patients reported they were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service. There were several examples of where the practice had gone the extra mile for patients.
• Generally, patients found the appointment system easy to use and reported that they could access care when they needed it.
• Services were tailored to meet the needs of individual patients and were delivered in a way to ensure flexibility, choice and continuity of care. The practice understood the needs of the services users and regularly engaged in the local community.
• The practice had been responsible for setting up and continuing to support additional services that benefitted their patients.
• Care provided was reflective of the needs of the population including those who worked on the nearby safari park and the small population of travellers.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• We saw that the practice provided support to victims of human trafficking; they opened outside normal practice hours to provide this service. The practice had continued to work with other agencies such as the police and offered to provide care for those that require services outside of the usual core GP services.
• The practice had over many years brought various services to the practice to benefit patients and to save them travelling to other clinics or hospital some distant away. These services included aural care, wound care and physiotherapy. They had worked and engaged with the local community and voluntary agencies ensuring their patients benefit from the support that was available including transport and support for patients who had suffered or who were receiving treatment for cancer.