Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection visit of Clement Road Medical Practice in August 2016. As a result of our comprehensive inspection the practice was rated as requires improvements for providing safe services. This was because we identified areas where the provider must make improvement and also some areas where the provider should improve.

We undertook a focused inspection on 12 April 2017 to check that the provider had made improvements in line with providing safe services. This report only covers our findings in relation to those requirements. You can read the report from our previous inspections by selecting the 'all reports' link for Clement Road Medical Practice on our website at www.cqc.org.uk.

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

• During our comprehensive inspection on 25 August 2016 we found that the practice could not demonstrate that the nurses also received safety alerts. When observing the alerts process during our follow up inspection we saw that alerts were disseminated across the whole practice team and acted on where required.

• When we inspected the practice in 2016 we found that systems were not effective across all areas such as following up on child missed appointments at hospital. As part of our most recent inspection, we noted that there was a process for monitoring and following up on missed hospital appointments, for adult and child patients. However, we found that the GPs did not always keep a record to evidence when they had reviewed the missed hospital appointments.

• Previously we found that risk had not been assessed in the absence of emergency medicine associated with minor surgery and fitting specific contraceptive devices. We also found that regular fire alarm tests and fire drills had not taken place in the practice. During our follow up inspection we observed adequate stock of emergency medicine suitable for the practice and the services provided. Records were kept to demonstrate that the fire alarm was frequently tested and we saw that a fire drill had recently taken place.

• When we inspected the practice in August 2016, we identified an area where the practice should improve with regards to supporting carers. During our follow up inspection we noted significant improvement and due to staff taking an active approach in identifying carers, we found that the carers register had increased from 3% to 4% between August 2016 and April 2017. These carers were offered support, flexible appointments and flu vaccinations.

• For instance, due to staff taking an active approach to identifying carers we found that the carers register had increased from 3% to 4% between August 2016 and April 2017. Flu vaccinations were offered to carers and carers were included in the programme for flu vaccinations to ensure that they were contacted and offered a flu vaccine.

• Since our previous inspection, comprehensive carer packs had been developed by the practice; these packs were handed out to all carers. The packs contained a wide range of information including signpost information to various carer support groups, this included support for young carers; to help the young carers identified on the practices register.

We identified one area of practice where the provider should make improvements:

• Improve record keeping specifically when reviewing missed hospital appointments, to reflect the system used in practice when reviewing and following up on missed hospital appointments.

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 Clement Road Medical Practice on 25 August 2016. Overall the practice is rated as good.

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

• We observed a patient-centred culture and we saw that staff treated patients with kindness and respect. Patients we spoke with and the completed comment cards we received described staff as helpful, caring and respectful.

• The practice was proactive in identifying and managing significant events. Opportunities for learning from internal and external incidents were maximised.

• The practice had some systems and processes in place to keep people safe and safeguarded from abuse however these were not always effective across all areas. The practice did not actively review or follow up on children who had missed hospital appointments. Additionally, the practice could not demonstrate that nurses received medicines and device alerts.

• We found that in in some areas governance arrangements were not always fully effective. Although policies and documented protocols were well organised and easily accessible to staff, we found that some of the policies were not current and not practice specific.

• There were some records in place to the support the practices arrangements for identifying, recording and managing risks. However, we found that records were not kept to support that regular fire alarm tests and fire drills had taken place in the practice and the practice had not assessed the risk in the absence of emergency medicine associated with minor surgery and fitting specific contraceptive devices.

• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. We saw that performance data across areas such as diabetes, dementia and mental health had gradually improved over the last 12 months.

• Although 3% of the practice list had been identified as carers, we found that the practice did not always take a proactive approach to ensure that carers were always supported.

The areas where the provider must make improvements are:

• Ensure that child safeguarding is robust, ensure that missed hospital appointments are reviewed and followed up where required.

• Ensure that all relevant staff members receive medicine alerts and medical device alerts.

• Ensure that fire risk is well managed and ensure that records are kept to demonstrate that fire alarms are regularly tested and that fire drills take place.

• Improve risk management, ensure risk is assessed in the absence of emergency medicine associated with minor surgery and fitting specific contraceptive devices.

The areas where the provider should make improvements are:

• Ensure governance arrangements are robust, policies must be practice specific, well embedded and reflect current guidelines.

• Maximise opportunities to support carers and ensure that supportive information is available in an accessible format.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice