Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Medical Centre on 5 October 2017. Overall the practice is rated as good.

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

• There was a clear leadership structure and staff felt supported by management.
• There was an open and transparent approach to safety. There was an effective system in place for reporting and recording significant events. We saw evidence that when things went wrong with care and treatment, patients were informed of the incident, received reasonable support, a written apology and were told about any actions to improve processes to prevent the same thing happening again.
• Significant events were discussed in recorded practice meetings where minutes were taken but not on a consistent basis. Clinicians explained that significant events were also discussed on an ad-hoc basis. We saw evidence that improvements were made as a result of significant events. The practice did not actively monitor trends in significant events to mitigate any risks and encourage improvements.
• Prescription stationary in the practice was kept safe but was not tracked throughout the practice.
• All electrical and clinical equipment was checked and calibrated to ensure it was safe to use and was in good working order. Staff told us they had equipment to enable them to carry out diagnostic examinations, assessments and treatments and there were sufficient stocks of equipment and single-use items required for a variety of interventions.
• We observed the premises to be tidy and clean.
• Staff had received training on safeguarding children and vulnerable adults relevant to their role.
• Practice specific policies were implemented and were available to all staff. These were updated and reviewed regularly.
• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients did not always rate the service highly in comparison with local and national averages.
• Cancer and cervical screening rates were below local and national averages.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. But there was no system in place to ensure that lessons learnt from individual concerns and complaints were shared with other staff or stakeholders.
• The leadership team had accounted for necessary changes in the practice’s future. The practice had endured considerable recent challenges in the structure and leadership
• The practice had in depth knowledge of their population and diversities and subsequent challenges.

There were several areas where the provider should make improvements:

• Monitor trends in significant events and ensure significant event discussions are recorded effectively.
• Share learning from complaints and their outcomes.
• Explore further opportunities to support an increase in cervical screening rates as well as breast and bowel cancer screening rates.
• Review the processes for identification of patients who are carers.

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 Millfield Medical Centre on 12 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to require improvement for providing safe services. It was good for providing effective, caring, responsive and well led services. 

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to health and safety issues and some areas of infection control. 
• Data showed patient outcomes were average for the locality. Although some audits had been carried out, there were no completed audit cycles to help drive improvement.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had considered the needs of its diverse population. They were also the designated practice by the local authority for migrants and patients who were seeking asylum and had developed strong working links with other agencies such as the police, local authority housing and the Red Cross.

• Information about services and how to complain was available. This information had been translated into some of the most common languages used by the registered patients.
• Urgent appointments were usually available on the day they were requested. However patients said that they had difficulty getting through on the telephone.
• The practice had a number of policies and procedures to govern activity. However we found that some policies relating to infection prevention and control and medicines management were not in place. 
• The practice had a meeting structure in place to monitor the quality of services being provided. However, this was not embedded across the staff team.
• The practice were proactive in seeking the views of their patients and used their feedback to shape services.

We saw areas of outstanding practice:

The practice had an ethnically diverse population and the staff were mindful of this in the way they supported people to access medical services. This meant that patients received support to achieve the best health outcome for them based on their individual need. The practice recognised that patients' psychological and emotional well-being had a direct effect on their health and had developed social interventions at their community centre. This was particularly beneficial to patients in vulnerable groups. For example:

• information sessions were provided in Urdu and Punjabi so that carers had a greater understanding of patients with dementia.

• there was an established exercise group for Asian women. We received comments cards completed by attendees that demonstrated four people had lost weight and their overall health and well being had improved.

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

The areas where the provider must make improvements are:

• Review and strengthen the infection control procedures to ensure that staff have access to current guidelines and there are systems in place to assure the provider that effective cleaning procedures are in place for all aspects of the practice. 
• There must be an up to date record to demonstrate staff immunity against Hepatitis B.
• Improve the non-clinical health and safety risk assessments that are in place to ensure that potential risks for staff, patients and visitors to the practice are identified and managed.

In addition the provider should:

• Develop and implement a relevant clinical audit plan so that audit findings can be used to improve patient outcomes.
• Complete a more detailed analysis to improve the learning outcomes following significant events and complaints and ensure these are more widely shared.
• Ensure the new leadership structure which includes lead roles, is communicated clearly to staff.
• Strengthen team communication and involvement with service developments. Ensure that all staff know how to access policies and procedures.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Patients we spoke with told us that they felt they were respected and were involved in making decisions about their care and treatment. Some patients we spoke with said they had difficulties in getting an appointment with a GP of their choice but they were always offered an alternative appointment. Patients were complimentary about the care and support they received from staff. One person said they felt they were, “Not just a patient”.

The surgery had an active patient participation group who supported the staff at the surgery to develop ways to support multicultural groups within the local community. For example the provider owned and ran a community centre used for exercise classes, more informal health clinics as well as hosting faith events, coffee mornings and English classes. Patents that we spoke with valued this service.

Staff that we spoke with and records that we checked showed that patients received care and treatment that promoted their health and well-being. We noted that staff worked in cooperation with other health and care professionals so that patients received the specialist services that they required.

Staff files that we checked showed that staff were effectively recruited using appropriate safety checks.

We found there was an effective complaints process in place. The provider was able to demonstrate service improvements that had been made as a result of patient feedback.