This practice is rated as Good overall. (Previous inspection 2 November 2015 – Good).

The key questions are rated as:

Are services safe? – Requires improvement

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 Birchington Medical Centre on 17 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk (with the exception of medicines) so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice did not have access to recommended medicines to treat patients in an emergency.
• We found systems for managing and storing medicines needed to be strengthened such as regularly reviewing patients on high risk medicines, the secure storage and monitoring of prescriptions and acting on safety alerts.
• The practice reported incidents, investigated them and learnt from them, changing practices to mitigate their reoccurrence.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients reported that they were able to access care when they needed it.
• The practice had processes to develop leadership capacity and skills.
• Staff were assigned roles but their associated responsibilities in some roles were not always well defined in respect of medicine management.
• There was a commitment to continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The area where the provider should make an improvement is:

• Strengthen their accountability structures to support good governance and management specifically in relation to medicine management.

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 Birchington Medical Centre on the 20 January 2015. Breaches of the legal requirements were found. Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook this focused inspection on the 2 November 2015, to check that the practice had followed their plan and to confirm that they now met the legal requirements. 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 Birchington Medical Centre on our website at www.cqc.org.uk.

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 of Birchington Medical Centre on 20 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well-led services. It required improvement for providing safe services. It was good for providing services for all patient population groups; older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed.
• Patient’s needs were assessed and care was planned and delivered in line with current legislation. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. Staff treated patients with kindness and respect, and maintained confidentiality.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• 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. The patient participation group (PPG) was active.

We saw one area of outstanding practice;

• The practice worked with two other local practices that together employed two nurses and a healthcare assistant specifically to oversee the care of older patients who were housebound and not previously seen by the practices’ clinicians on a regular basis.

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

Importantly the provider MUST;

• Review its infection control management to help ensure all areas of the practice are clean, records kept of domestic cleaning as well as ensure that infection control activity is monitored and assessed fully.
• Review their system to monitor blank prescription forms.

The provider SHOULD also;

• The provider should ensure all relevant staff have up to date knowledge of the Mental Capacity Act 2005 and are aware of the practice’s vision and strategy.
• Revise their governance processes and ensure that all documents used to govern activity are up to date and contain relevant contact details of external bodies for staff to refer to.
• Review information about the practice to ensure it is up to date and available in relevant formats to all patients
• Review their process for recording complaints processes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Since our last inspection of 14 August 2013 we have found that the provider has made the necessary improvements to meet the required standards of regulation.

Processes around recruiting and monitoring staff had been changed to reflect current legislation. Personnel records were complete and there were suitable arrangements in place to review staff registrations, knowledge and skills.

The provider had an effective system in place for monitoring the quality of the service and to seek the views of patients using the service. There were complaints procedures in place and we found that complaints had been dealt with appropriately.

During our inspection we spoke with nine people who used the service and received some positive feedback. One person told us, "The doctors are caring; I have always found that the staff are nice, polite and friendly."

People who used the service told us they were satisfied and felt involved with the care and treatment they received. People told us they felt their medical issues were taken seriously and dealt with appropriately. However, people told us they felt they had to wait too long for a routine appointment but told us they would be seen on the day if they had an urgent medical issue.

Although we found the location to be clean, tidy with good infection control practices taking place, we found no evidence that adequate processes, such as audits and reviews were taking place.

Processes around recruiting and monitoring staff were not robust. Personnel records were incomplete and there were no suitable arrangements in place to review knowledge and skills.

The provider did not have an effective system in place for monitoring the quality of the service or to seek the views of people using the service. Although there were complaints procedures in place we found that complaints were not dealt with appropriately.

We carried out a focussed inspection at Birchington Health Centre on 22 January 2019 to confirm whether the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 28 November 2018.

A warning notice had been issued in relation to breaches of regulation 12, safe care and treatment in relation to the practices management of medicines. The practice is required to be compliant with the notice by 07 January 2019. Two regulatory notices have also been issued for breaches of regulation 13, safeguarding and regulation 17 for good governance.

This inspection focussed on the risks identified in the warning notice in respect to the management of medicines. The inspection was not rated as not all areas of the domains were inspected. However, a comprehensive rating inspection has been planned.

We found that:

• The practice had reviewed how they managed medicines alerts and had ensured all patients potentially affected had been appropriate reviewed and their medicines amended as necessary.
• The practice had changed their prescribing practices for high risk medicines requiring a GP to authorise all prescriptions.
• The practice had reviewed their systems for recording medication reviews to ensure they were accurate.
• The practice ensured the safe disposal of patient medicines.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice