Letter from the Chief Inspector of General Practice

In March 2015 we found concerns related to infection control, health and safety risk assessments and access to appointments for working age people (including those recently retired and students) during a comprehensive inspection of Cookham Medical Centre. Following the inspection the provider sent us an action plan detailing how they would improve these areas of concern and a timeframe for completion.

We carried out a focused inspection of Cookham Medical Centre on 3 February 2016 to ensure these changes had been implemented and that the service was meeting regulations. Our previous inspection in March 2015 had found a breach of regulations relating to the delivery of safe services and care of patients of working age.

We found the practice had made improvements since our last inspection on 11 March 2015 and they were now meeting the regulations relating to safe care and treatment and good governance that had previously been breached.

Specifically the practice had:

• Maintained cleanliness in the practice and monitored that cleaning standards had been upheld through regular spot checks.

• Carried out risk assessments relating to fire, legionella and control of substances hazardous to health.

• Undertaken routine building and utilities maintenance to ensure staff, patient and visitor safety.

• Reviewed online access arrangements and worked with the patient participation group to identify where improvements to service access could be made.

We have offered a new rating to reflect these changes.

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 Cookham Medical Centre on 11 March 2015. This was the first inspection of the practice.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well led services. However, the practice requires improvement in the provision of safe services and should review the availability of appointments for patients who work. Specifically, control of infection processes need to be improved as do some aspects of monitoring quality and maintaining records.

The practice had undergone a period of significant change during 2014. Two GP partners had left the practice and there had been an interim period before new partners came into post. The practice manager had been in post for eight months. Prior to their coming into post a locum manager had supported the practice.

Our key findings for the practice were:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Staff had a clear understanding of safeguarding both vulnerable adults and children and there were examples of appropriate safeguarding alerts being raised.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• 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).

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a firm commitment to training and staff were committed to maintaining and improving their skills and abilities to carry out their roles.

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

Importantly, the provider must:

• Implement a cleaning specification for the practice and monitor cleaning standards. Reduce the risk of cross infection from cleaning equipment by ensuring appropriate segregation of such equipment and undertake a Legionella risk assessment.
• Ensure systems are in place to identify, assess and manage risks to the health, safety and welfare of patients and others and maintain appropriate records that support such systems.

In addition the provider should:

• Ensure that records of all pre-employment checks required by legislation are retained.
• Expand the number of completed clinical audit cycles to monitor clinical quality and systems to identify where action could be taken.
• Consider improved access to appointments for patients of working age and expand the availability of online access to services.
• Review and undertake a risk assessment to determine which emergency medicines should be held in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice