Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Charles Road Surgery on 2 July 2015. 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 and record incidents and near misses. Staff used significant events and national and local safety alerts to improve the service.
• The practice assessed risks to patients and managed these well.

• The GPs and practice nurses assessed patients’ needs and planned and delivered care following best practice guidance.

• Staff received training appropriate to their roles and the practice identified and planned future training and development needs.

• Patients told us they were involved in their care and decisions about their treatment. They were positive about the practice which they described as helpful, competent, polite, respectful and re-assuring. There were differences between the very positive information we obtained and the less positive results of the national GP patient survey.
• Information about services and how to complain was available and easy to understand but responses to complaints were not always fully documented to support shared learning.
• 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 worked closely with its patient participation group and acted on feedback from them and other sources.

• The practice was developing more comprehensive governance systems to support the clinicians and ensure the practice was managed effectively.

We saw some areas of outstanding practice including:

• The practice worked with the chair of the PPG to facilitate the funeral and burial needs of Muslim patients, including when this was out of hours and the practice was closed. Community leaders and patients and their families had the contact details for the chair of the PPG. When a patient died the PPG chair contacted the practice so that death certificates could be arranged without delay and burials could take place.

• The practice was alert to the potential risks of female genital mutilation (FGM) and forced marriage. They provided patients with information and access to specialist support. They were sensitive to the importance of taking great care to protect patients who asked for help or who they believed might be at risk.

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

Importantly the provider should:

• Review whether the practice is due for its five yearly electrical installation checks to be carried out.

• Take the results of patient feedback, including the national GP patient survey into account when planning improvements at the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

In order to target our inspections effectively we continually gather information about services. This may include information from health professionals and other staff; people who use services and family members. We had received information which led us to review circumcision procedures at a number of GP practices. In order to do this CQC inspectors were accompanied by a specialist advisor in urology.

The visit to the practice was unannounced; this meant that the provider and staff at the practice did not know we were coming.

One of the GPs at Charles Road Surgery was undertaking non – medical circumcisions on male babies. Male circumcisions that are performed where there is no health need are termed non - medical circumcisions. They are generally completed for cultural reasons.

We spoke with the parents of four babies who had recently had a circumcision at the practice. They told us they were given clear details of the procedure and the associated risks. Infants were pre assessed prior to the surgery and a medical history taken. We saw, and parents told us information was given in relation to potential complications and post-operative care. However there was no system in place to ensure that, where appropriate, both parents had given consent for the procedure.

Systems were in place to monitor the quality of the services provided at the practice. The absence of regular and up to date circumcision audits meant that opportunities to monitor and improve the quality of that particular service at Charles Road Surgery had not been utilised.