Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crown Heights Medical Centre on 4 May 2016. The overall rating for the practice was inadequate and the practice was placed into special measures. We carried out a further announced comprehensive follow up inspection of the practice on 29 November 2016 to review progress. The practice had made improvements to some areas that it was in breach of regulations for and as a result was taken out of special measures. The overall rating for the practice was requires improvement. Both the report from the 4 May and 29 November 2017 can be found by selecting the ‘all reports’ link for Crown Heights Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focussed inspection carried out on 22 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 29 November 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was now a safe system in place for storage of vaccines.

• The practice had learned from significant events and improved processes around storage of vaccines.

• The practice had embedded systems and protocols in place which were followed when there were issues with cold chain storage. There was a safe system in place to ensure that when patients were affected, they were contacted in a timely manner.

• The practice had continued to work to reduce exception reporting levels for several clinical indicators.

• The practice had documented care plans which were discussed with patients who had long term conditions.

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

In addition the provider should:

• Continue to monitor exception reporting levels to ensure they are more in line with local and national averages.

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 Crown Heights Medical Centre on 29 November 2016 to assess the improvements made at the practice. Overall the practice is now rated as requires improvement

We had previously inspected on 4 May 2016 when we rated the practice as inadequate overall. Specifically, the practice was rated as inadequate for safe and for well-led, and requires improvement for effective, caring and responsive.

Areas which did not meet the regulations following our inspection in May 2016 were:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.
• There was no evidence of learning and communication with staff about reported safety incidents.
• Appointment systems were not working well so patients did not receive timely care when they needed it. This was particularly around the ineffective phone system at the practice that was not sufficient to keep up with the volume of patient calls.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
• Patient complaints were not consistently investigated or responded to.

On 29 November 2016 our key findings across all the areas we inspected are as follows:

• There was a new approach to the running of the practice with an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to the safe care of patients were more clearly managed, with the exception of the storage of vaccines.
• Staff assessed patients who attended the practice had their needs and delivered care in line with current evidence based guidance. However, not all patients with long term care needs had a regular assessment.

• Staff had received updated training and had the skills, knowledge and experience to deliver effective care and treatment.

• Information about services and how to complain was available and easy to understand. Complaints were investigated appropriately and in a timely manner.
• 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 proactively sought feedback from staff and patients, which it acted on. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The provider was aware of and complied with the requirements of the Duty of Candour.

However, there remain areas where the provider must make improvement. The practice must:

• Ensure safe systems are in place for the storage of vaccines.

• Regularly review the needs of patients with long term conditions to ensure care and treatment is safe and appropriate.

There was also an area where the practice should make improvement:

• Increase the involvement and satisfaction of patients in planning and making decisions about their care and treatment

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 Crown Heights Medical Centre on 4 May 2016. The overall rating for the practice was inadequate and the practice was placed into special measures. We carried out a further announced comprehensive follow up inspection of the practice on 29 November 2016 to review progress. The practice had made improvements to some areas that it was in breach of regulations for and as a result was taken out of special measures. The overall rating for the practice was requires improvement. Both the report from the 4 May and 29 November 2017 can be found by selecting the ‘all reports’ link for Crown Heights Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focussed inspection carried out on 22 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 29 November 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was now a safe system in place for storage of vaccines.

• The practice had learned from significant events and improved processes around storage of vaccines.

• The practice had embedded systems and protocols in place which were followed when there were issues with cold chain storage. There was a safe system in place to ensure that when patients were affected, they were contacted in a timely manner.

• The practice had continued to work to reduce exception reporting levels for several clinical indicators.

• The practice had documented care plans which were discussed with patients who had long term conditions.

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

In addition the provider should:

• Continue to monitor exception reporting levels to ensure they are more in line with local and national averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our inspection in June 2013 we found that the practice did not have suitable arrangements to ensure patients were protected from the risks of abuse and that appropriate processes or records were not in place to evidence pre-employment checks for staff.

We completed a follow up review of the Crown Heights Medical Centre in January 2014 and found they had ensured that patients were protected from the risks of abuse. We noted that pre-employment checks were undertaken and recorded on staff personnel files.

We spoke with ten patients, five members of staff and the provider. Patients were complimentary about the all the staff and medical centres services. We found that although the practice was busy the majority of patients could get an appointment when they needed one, especially the same day. One patient said "I can always get an appointment and seen the same day especially when I’ve contacted the rapid access clinic". They told us they thought the medical centre was clean and tidy.

Two patients told us their GP "was fantastic, best they had", another told us "the doctor listens to what I say" and "doctors are kind and polite".

Patients views and experiences were taken into account in the way the service was provided and delivered in relation to their care. The provider took adequate steps to ensure that patients were protected against the risks of receiving care or treatment that was inappropriate or unsafe. However, the provider had not ensured all staff had received appropriate training in safeguarding vulnerable adults.

Patients were protected from the risk of infection because appropriate guidance had been followed. The provider had an effective system to regularly assess and monitor the quality of service that patients received

The provider and practice manager were aware of the need to assure themselves that all new staff were recruited correctly. However, there was insufficient documentation to demonstrate that this happened in practice.