Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Medical Centre on 10 November 2015. 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 an effective system in place for reporting and recording significant events.
• Most risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Data showed patient outcomes were average or above for the locality. Audits had been carried out with evidence that they were driving performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice used innovative and proactive methods to meet patients’ needs, specifically tailoring their services for patients from vulnerable groups.
• Information about services and how to complain was available and easy to understand and a range of patient information was available in Tamil.
• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day. Patients were able to get routine appointments quickly.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Policies and procedures were not always easily accessible for staff but there was evidence that they were updated to reflect changes in practice systems.
• 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 and they had an active Patient Participation Group (PPG).
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice:

• The practice had tailored its service and there were innovative approaches to promoting patient education, especially in vulnerable groups. The practice had developed patient education information for a range of conditions in Tamil, including a diabetes book and provided new patient health checks to promote self-management. The practice reported they had shared their information leaflets with other local health services to support Tamil patients.

• The practice had tailored its services for vulnerable patients; staff were able to speak twelves languages, chaperones that spoke Tamil were available and information was available in Tamil in the patient waiting area including information for bereavement support.

• The practice had an in-house pharmacist and reviews for patients over 75 were completed jointly by the practice nurse, GP and practice pharmacist where indicated. Joint home visits were undertaken for housebound patients over 75 to complete their care plans, to ensure that patients’ holistic needs were assessed. The pharmacist was involved with ensuring that the medicines that patients from overseas were taking were replaced with appropriate UK equivalents.

The areas where the provider should make improvement are:

• Ensure that emergency equipment includes access to defibrillator pads for children.

• Ensure that the practice has a updated record of assessed risks

  relating to health and safety of the premises including those related to

  asbestos and portable appliance testing.

• Ensure the practice has systems in place to monitor staff training effectively, including mandatory training requirements and ensure that practice policies and procedures are easily accessible for staff.

• Ensure that minutes are recorded for partnership meetings so actions can be monitored.

• Consider how to improve patient satisfaction regarding access to appointments as indicated in the GP patient survey.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Central Medical Centre is a GP surgery in Morden. The practice was set out over two floors and had seven consulting rooms and one treatment room. The practice has been at this location for approximately 30 years. They have approximately 8500 patients on their list and there were two partners and four salaried GP’s. They also have one full-time and two part time nurses. All the GP’s had individual patient lists so that they can provide patient-centred treatment and ensure continuity of care. The practice is registered to carry out the regulated activities of diagnostic and screening services, family planning, midwifery and maternity and treatment of disease, disorder and injuries.

We found that the service was safe, effective, well led, caring and responsive to patient’s needs. The practice had a high proportion of patients from the Tamil community (approximately 55%) and we saw that the practice responded to the needs of these patients very well. Approximately 10% of these patients had been with the practice for over 15 years and more and although some had moved out of the practice locality area the Primary Care Trust (PCT)now known asClinical Commissioning Group (CCG) recognised the importance of continuity of care and had allowed special arrangements for the patients to continue to be registered with the practice.

Effective support and counselling services were in place to assist patients who require psychology services, including refugees who accessed the service. The practice had systems in place for the management of chronic long-term conditions such as diabetes and high blood pressure. Services were in place to support mothers and babies; this included a visiting midwifery service, immunisation programme and health visitor. Sexual health education and contraception services were available for young people. Older people had access to a range of services to maintain their health and if they had mobility issues were able to request home visits. Access arrangements were made in consideration of the working age population.

We spoke with 12 patients and received 12 completed comment cards. The feedback we received was very positive. People described the GP’s and staff as friendly, helpful and caring and were confident in their assessments. The patients we spoke with during the inspection were complimentary about the practice. They felt the service provided was to an excellent standard and responsive to their needs.