Letter from the Chief Inspector of General Practice

We previously inspected Coseley Medical Centre on 6 October 2016. As a result of our inspection visit, the practice was rated as requires improvement overall with a requires improvement rating for providing effective and responsive services; this was because we identified some areas where the provider should make improvements. The practice was rated good for providing safe, caring and well led services.

We carried out an announced comprehensive inspection at Coseley Medical Centre on 30 August 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Coseley Medical Centre on our website at www.cqc.org.uk.

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

• There were processes in place for formally reporting incidents and systems ensured compliance with the requirements of the duty of candour. Significant events and complaints were discussed with all staff and reflected on during practice meetings.

• The practice operated effective prescribing systems. We saw that patients prescribed high risk medicines were regularly monitored and reviewed. Prescribing was well monitored and audits were conducted to drive improvement in prescribing and to ensure adherence to best practice guidelines.

• In addition we saw that the practice nurses administered vaccines using patient group directions (PGDs) and patient specific directives (PSDs) were in place to support health care assistant’s role when administering vaccinations. PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment. PSDs are written instructions signed by a prescriber, for medicines to be supplied or administered to a named patient after the prescriber has assessed the patient on an individual basis.

• During our most recent inspection we found that the practice had improved their audit programme overall, audits were repeated and action plans were produced to monitor improvements. In addition to clinical audits we saw that the practice regularly audited their processes and systems to ensure good governance.

• The practice had signed up to pilot the Dudley clinical commissioning group’s long term condition framework; Dudley Quality Outcomes for Health (DQOFH). DQOFH data for August 2017 indicated that practice performance was in the top threshold for most areas of clinical care.

• The results from the most recently published national GP patient survey highlighted that some responses were below local and national averages, specifically in relation to telephone access. Although we noted some improvements in this area, at the point of our inspection we found that the practice were yet to be able to demonstrate sustained improvement and improved satisfaction.

The areas where the provider should make improvement are:

• Continue to explore ways to improve satisfaction rates with regards to access.

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 Coseley Medical Centre on 6 October 2016. Overall the practice is rated as requires improvement.

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

• We saw that staff were friendly and helpful and treated patients with kindness and respect. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice was proactive in identifying and managing significant events. We noted that in some areas governance arrangements reflected best practice, for instance across risk management and areas to support good infection control practice.

• However, in other areas governance arrangements were not as effective. For example, we found that the practice did not follow an effective system for managing uncollected prescriptions.

• Although we saw evidence to support that the health care assistant was trained to administer flu vaccines, however the evidence provided during our inspection did not represent a legal patient specific directive (PSD). Additional evidence was later provided to the lead inspector to confirm that the PSDs were in place to support the administration of flu vaccinations by the health care assistant.

• Performance data for 2014/15 highlighted that the practice was below average across areas of the Quality and Outcomes Framework (QOF). Additional data provided by the practice demonstrate that improvements had been made, however performance was still low for Diabetes care.

• Results from the national GP patient survey published in July 2016 highlighted poor responses regarding access. We found that some measures had been implemented to improve this including measures to ease telephone traffic, promotion of telephone consultations and the pharmacy first scheme and changes to reception rotas to help manage phone lines.

• Staff spoken with demonstrated a commitment to providing a high quality service to patients. During our inspection members of the active patient participation group (PPG) described a practice team who listens and acts on patient feedback and we saw examples of how the practice had acted on patient feedback and suggestions during our inspection.

The areas where the provider should make improvements are:

• Ensure that governance arrangements are established across all areas and ensure that policies are well embedded to support systems support systems for managing uncollected prescriptions.

• Ensure that effective systems and processes are established in order to sustain and continue to work on improving areas identified for improvement from the national GP patient survey responses.

• Continue to identify carers in order to provide further support where needed.

• Ensure that vaccines are stored in line with recommended guidelines.

• Ensure that staff have a clear understanding of legal requirements to support them when administering vaccines; including patient specific direction (PSD) governance and systems.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously inspected Coseley Medical Centre on 15 November 2013. We found that the provider did not have appropriate systems in place for monitoring the quality of service provision. We asked the provider to submit an action plan outlining how they intended to make improvements to address the issues identified.

At this inspection visit we looked to see if improvements had been made. We spoke with two members of the reception staff and the practice manager. We also spoke with three patients so that we could get their view with regards to the service provided. We received mostly positive comments from the patients in regards to the service and staff.

We saw that the practice had addressed most of the issues identified and was working to address others. Staff members we spoke with told us that the changes being made were having a positive impact on patients and also staff.

During our inspection we spoke with seven patients and eight members of staff.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. A patient said: "Staff explain things. I can ask questions. I am happy with the information provided".

The patients we spoke with provided positive feedback about their care. A patient told us: "It's very good. I cannot fault them". Patients who received regular medicines told us they were regularly reviewed to check that they still needed them.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

We found that staff had received appropriate training for the specialist roles they carried out. They also had annual appraisals. This meant that they had been adequately assessed as being competent.

The provider had failed to provide some essential training for staff. The provider did not have appropriate systems in place for monitoring the quality of service provision. There was not an established system to regularly obtain opinions from patients about the standards of the services they received. This meant that patient feedback could not be included in the on-going improvements.

At our previous inspection on 30 August 2017, we rated the practice as requires improvement for providing responsive services as the latest results from the national GP patient survey published in July 2016 at the time) highlighted low satisfaction with regards to access. At this inspection we found that the practice had taken steps to improve the telephone access. This has been a recent change and although the actions taken were positive, evidence to show improvement in patient satisfaction was not available. Consequently, the practice is still rated as requires improvement for providing responsive services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice