Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bilton Medical Centre on 10 May 2016. Overall the practice was rated as good. However, breaches of the legal requirements were found leading to a rating of requires improvement in the key question of Safe. After the inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to the safety of the practice.

We undertook a focussed follow up inspection at Bilton Medical Centre on 14 December 2016 to check that the practice had met the requirements. This report only covers our findings in relation to those requirements.

You can read the full comprehensive report which followed the inspection in May 2016 by selecting the 'all reports' link for Bilton Medical Centre on our website at www.cqc.org.uk.

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

• Risks to patients were assessed and well managed.
• Staff who acted as chaperones had undertaken a Disclosure and Barring Service check (DBS). (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).
• Vaccines were stored and managed appropriately in line with Public Health England guidance.
• The practice had a number of policies and procedures to govern activity, and we saw that these had been reviewed.
• Patients who did not need to see a GP could be directed to the ‘Pharmacy First’ Scheme by reception staff who followed a clear protocol for this.

The areas where the provider should make improvements are:

• Where the non-therapeutic circumcision of male children is performed, (for religious or cultural reasons) the practitioner should continue to give consideration to British Medical Association good practice guidelines which state that “usually and where applicable both parents must give consent for non-therapeutic circumcision”.

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 Bilton Medical Centre on 10 May 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Patients said they were involved in decisions about their care and treatment and they had high levels of confidence in the GPs at the practice, when compared to Clinical Commissioning Group (CCG) and national averages.
• Risks to patients were assessed and well managed, with the exception of those relating to the storage of vaccines.
• The practice engaged with the local community and had been involved in local project fundraising events and a coffee morning for isolated people was scheduled for later in the month.
• Some staff who had worked at the practice for a number of years were acting as chaperones without a Disclosure and Barring Service check (DBS). (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).
• The majority of patients said they were treated with compassion, dignity and respect.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• Patients could attend the surgery at any time to check their own blood pressure with a machine which had been purchased by the practice and was situated in reception.
• GP sessions were not consistently held on Monday, Tuesday or Wednesday afternoons. The GP was on call for emergencies only.

• The practice does not offer an early or extended hours clinic.
• We were told of examples of reception staff asking clinical questions when patients rang for appointments, patients would then be directed to the Pharmacy First Scheme if the receptionist thought this was appropriate. This non-clinical intervention could potentially put patients at risk.

The areas where the provider must make improvements are:

• The practice must ensure that all vaccines are stored and managed properly so that immunisations are carried out safely and efficiently in line with Public Health England guidance.
• The practice must review the process of redirecting patients to the Pharmacy First scheme and ensure that this is safe and clinically led.

In addition the provider should:

• Where the non-therapeutic circumcision of male children is performed, (for religious or cultural reasons) the practitioner should give consideration to British Medical Association good practice guidelines which state that “usually and where applicable both parents must give consent for non-therapeutic circumcision”.
• The practice should ensure that all staff who act as chaperones for patients have undergone a Disclosure and Barring Service check (DBS).
• Review the availability of pre-bookable appointments.
• The practice should continue to review the results of patient satisfaction surveys and ensure that it can meet the needs of the patient population in the future and improve access.
• The practice should review the number of available GP appointments and ensure that this meets patient needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Our inspection on the 11 October 2013 found the practice did not have robust systems in place which were designed to assess the risk of and prevent and control the spread of health care associated infections. Following the inspection the provider wrote to us and told us they would take action to ensure they were compliant with these essential standards.

At this inspection we found that improvements had been made. The provider had reviewed their policies and procedures and implemented new systems which assessed the risk of and prevented the spread of health care associated infections.

We observed staff speaking with people on the telephone and in person. We saw staff were friendly, polite and offered choices to patients. We found that people who used the service were treated with dignity and respect. We spoke with three people who used the service; one said, "They do listen. The staff are a lot friendlier and very polite, I cannot fault them. I have raised a suggestion about having different time slots for those who are working and to try online appointments." Another person said, "I never get to see the GP I always seem to see the locum." Another person said, "I can ring early to get a same day appointment but have to wait as they always run late."

People who used the service were protected against the risk of abuse. Staff received training in abuse awareness and protecting children and vulnerable adults every six months. The policies and procedures were available to all staff in relation to safeguarding.

We saw the practice appeared clean and people who used the service told us the practice was always clean. However we found the practice did not have robust systems in place which were designed to assess the risk of and prevent, detect and control the spread of health care associated infection.

There were effective recruitment and selection processes in place.

There was an effective complaints system in place. Complaints people made were responded to appropriately.

We saw evidence the provider carried on two regulated activities but had not registered these with the CQC. We discussed this with the provider and the practice manager that under the Health and Social Care Act 2008, providers must, by law, register with CQC if they carry on a regulated activity. It was the provider’s responsibility to make sure they are appropriately registered to carry on the activities they provided. The provider agreed to immediately submit an application to register for surgical procedures and maternity and midwifery services.