Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clarendon Medical Centre on 26 May 2016. 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.

• 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.
• Patients could access appointments and services in a way and at a time that suited them. The GP patient survey showed that 85% of patients were satisfied with the GP practice opening hours which was above CCG and national averages. Services were flexible and provided choice and continuity of care for patients.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, patients who required blood tests could choose to have these carried out the same day, within 24hours or book a time slot to suit their individual needs.
• The percentage of patients with a mental health issue who had a comprehensive, agreed care plan in their notes was 95% which was better than the CCG average of 90% and the national average of 88%.
• The practice was proactive in its approach towards improving patient outcomes, working with other local providers to share best practice and using technology. There were innovative approaches to providing integrated patient-centred care. The practice was trialling an application for mobile smart phones to enable patients to submit requests for prescriptions, access health care information and receive notifications.
• Risks to patients were assessed and well managed in most cases. However, we were told that there had been some occasions when staff who had not been DBS checked carried out chaperone duties. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). We did not see a risk assessment for this.
• The practice was unable to evidence references for all staff. We were told that staff were recommended verbally to the practice or were well known within the local community.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• 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. Staff told us that they would feel confident to raise any concerns with the lead GP.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice was able to respond to the local demand for non-therapeutic circumcision. We were told that the clinician attempted to gain consent from both parents but saw evidence that this was not always achieved.
• The practice Patient Engagement lead had recently arranged First Aid training at the practice and 16 patients had attended. Regular communications were sent to patients encouraging them to join the PPG or to attend events such as a recent healthy eating event.

We saw areas of outstanding practice:

The patient participation group was integral to the running of the practice and the individual needs and preferences of patients were central to the planning and delivery of care. We saw numerous examples of changes and improvements made by the practice to enhance services and the patient experience. For example, the practice had employed a staff member who could speak Bengali as a result of PPG and patient feedback. In response to patient concerns and in discussion with the PPG, the practice has continually reviewed access to appointments at the surgery. As a result the practice were able to evidence a 38% increase in appointments from 2014-2016.

The practice offered a level two diabetes clinic where patients could be commenced on insulin therapy without having to attend the hospital. (Insulin is a drug used for diabetics which keeps blood sugar levels from getting too high or too low). In an area of high deprivation where travel costs could be prohibitive for some patients, services were planned to meet patient needs. This innovative combined clinic could offer a multi-disciplinary service, including the input of a specialist dietician, a podiatrist and the advanced practitioner pharmacist. By offering these services closer to the patients’ home the practice could also reduce the burden on hospital services.

The practice had responded to the specific needs of its patients and held a monthly review of patients on the avoidable unplanned admissions register and proactively reviewed those who attended accident and emergency. All patients who were identified as high risk of admission to accident and emergency had a personalised care plan. This person-centred approach would involve other services where required particularly for those who were most vulnerable. Figures showed that the number of emergency admissions and the number of people who were seen in accident and emergency had reduced since 2014.

The areas where the provider should make improvement are:

The practice should carry out a risk assessment of all staff who act as chaperones for patients to determine if a Disclosure and Barring Service check is required (DBS).

The practice should ensure that it obtains written references and records any verbal references for newly recruited staff.

Where the non-therapeutic circumcision of male children is performed, (for religious or cultural reasons) the practitioner should continue to give consideration to British Medical Association good practice guidelines which state that “usually and where applicable both parents must give consent for non-therapeutic circumcision”.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice