Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 2 December 2015. Breaches of legal requirement were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet this legal requirement in relation to the regulatory breach of the Health and Social Care Act 2008 (Regulated Activities) 2014, Regulation 12 Safe care and treatment and Regulation 19 Fit and proper persons employed.

We undertook this focused inspection on 10 August 2016 to check that they had followed their plan and to confirm they now met the legal requirement. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Avenue Medical Practice on our website www.cqc.org.uk.

Overall the practice is rated Good. Specifically, following the focused inspection we found the practice to be good for providing safe and well-led services.

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

• All staff who performed chaperone duties had received training for the role and a Disclosure and Barring Service (DBS) check had been completed (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

• Systems and processes were in place to keep people safe. For example, the system to check and monitor the temperature of the medical fridges had been reviewed. The healthcare assistants had attended a vaccination and immunisation training programme. We saw evidence that patient specific directions were attributable to a prescriber and demonstrated individual patient consideration to allow healthcare assistants to administer vaccinations. We reviewed a random sample of medical consumables within the practice and all were found to be within their expiry date. The practice had implemented a system to monitor and control this.

• The partners had reviewed the governance framework to support performance and deliver good quality patient care. We saw evidence staff had received an up to date job description. All had received an appraisal within the last 12 months with the exception of the nurse practitioner who had a date for this scheduled. We saw evidence a computerised training matrix had been implemented to monitor staff training needs.

• We saw evidence that risk assessments had been completed. A building health and safety risk assessment and a legionella risk assessment had been completed (legionella is a term for a particular bacterium which can contaminate water systems in buildings).

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 The Avenue Medical Practice on 2 December 2015. Overall the practice is rated as requires improvement.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• There were some systems in place to reduce risks to patient safety. However, we identified areas where improvements were required. For example, there was no health and safety risk assessment of the premises or legionella risk assessment.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Most staff had received training appropriate to their role. However, training records did not identify all the training staff had completed.
• 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.
• Patients said they found it easy to make an urgent appointment although they had to wait three weeks for a routine appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by the GPs. However, it was evident the practice was in a transition period following recent changes in management although evidence some changes had been made was seen.
• The registered provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure the proper and safe management of medicines is reviewed in line with Public Health England guidance with regard to monitoring the fridge temperature.

• Ensure the process for healthcare assistants to administer vaccinations is in accordance with current legislation and guidance.

• Ensure a system to check stock of clinical consumables, for example, syringes and needles are within their expiry date is implemented.

• Ensure all staff acting as a chaperone are trained to do so and have had a Disclosure and Barring Service (DBS) check carried out.

In addition the provider should:

• Provide staff with a job description relevant to their role and review the appraisal system.

• Maintain records of all staff training.

• Implement a system to ensure all health and safety risks relating to premises are identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice