Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the Brunswick Medical Centre on 22 November 2016. The overall rating for the practice was requires improvement.

Under the key question of the practice providing Safe services, there had been insufficient evidence that staff recognised and acted upon significant adverse events, with appropriate investigation, reflection and learning. The practice had adopted the use of Patient Group Directions (PGDs) to allow nurses to administer medicines in line with legislation, but the PGDs had not been completed correctly and were therefor invalid. We served a requirement notice relating to the practice’s failure to comply with Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also noted concerns highlighted by the GP Patient Survey, regarding continuity of care and patients’ satisfaction with GP consultations, under the key question, Caring.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘reports’ link for the Brunswick Medical Centre on our website at http://www.cqc.org.uk/location/1-1249244528. After the inspection, the practice sent us a plan of the action it intended to take to improve the quality of care and meet the legal requirements under the key question, Safe.

This inspection was an announced focussed inspection carried out on 13 July 2017 looking at the issues previously identified and to check and confirm that the practice had carried out its plan to meet the legal requirements. We found that the practice had taken appropriate action to meet the requirements of the regulations relating to providing a safe service.

In addition, under the key question of Caring, we looked at continuity of care and patients’ satisfaction with GP appointments. We saw evidence from the most recent GP Patient survey, the practice’s Friends and Family Test results and the provider’s own patient survey data, which showed a general sustained improvement since our inspection in November 2016.

Accordingly, we have revised the practice’s ratings in respect of providing a safe and caring service, which has led to a revision in the overall rating to Good.

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 on 22 November 2016. Overall the practice is rated as requires improvement.

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

• The practice had systems for reporting and recording significant events, and for processing patient safety alerts. However, there was insufficient evidence that all incidents were recognised and treated as significant adverse events, with appropriate reflection and learning.
• Patient Group Directions, allowing nurses to administer medicines in line with legislation, had not been signed, authorised and validated by an appropriate person within the practice.
• The practice made significant use of locum GPs and this had a negative impact on continuity of care and possibly on patients’ perception of consultations with GPs. Results from the GP patient survey were below average for this aspect of care. Results of the provider’s own ongoing patient survey indicated that patient satisfaction was improving.
• 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.
• Current data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above local and national averages.
• Patients told us that access to the service was usually good, although there were sometimes delays getting routine appointments. Patients were positive in their response regarding the availability of urgent appointments.
• Information about how to complain was available and easy to understand. Comments and complaints were analysed and improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice was aware of and complied with the requirements of the duty of candour.

However, there were areas of practice where improvements are required.

The practice must: -

• Ensure that all safety and other significant incidents are recognised and treated as significant adverse events, with appropriate investigation and reflection, and learning from the events being disseminated to all staff.
• Ensure that Patient Group Directions, allowing nurses to administer medicines in line with legislation, are signed, authorised and validated by an appropriate person within the practice.

In addition, the practice should: -

• Continue with efforts to improve continuity of care and patients’ satisfaction with GP consultations.
• Continue with plans to review the provider's governance policies to cover local issues and implement them fully at the practice.
• Take steps to increase the frequency of patient participation group (PPG) meetings. It should encourage more participation from younger patients who are not well-represented on the PPG, despite making up a significant proportion of the patient list.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice