We carried out an announced comprehensive inspection at Derwent Crescent Medical Centre on 2 April 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

•what we found when we inspected

•information from our ongoing monitoring of data about services and

•information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

•Patients received effective care and treatment that met their needs.

•Staff dealt with patients with kindness and respect and involved them in decisions about their care.

•The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

•The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We rated the practice as requires improvement for providing safe services because:

•The practice did not use purple topped bins for the disposal of medicine waste containing hormones.

•Blank prescription stationery was stored in locked cupboards however, the key to the cupboard was accessible to all staff. Access should be restricted where possible. Receipt of blank prescription stationery was not always recorded.

•Registered nurses worked to patient group directions to administer vaccinations. The patient group directions were up to date and the lead GP had given clinical authorisation for the nurses to work to the directions. The Healthcare Assistant administered flu vaccinations but we were not assured that a prescriber completed the correct authorisation prior to vaccinations being administered. Nurses sometimes gave other prescription only medicines (for example contraceptive long acting injection) without an appropriate authorisation being in place.

•The Clinical Pharmacist monitored the prescribing of high dose opiates. However, our inspection found examples of prescriptions for controlled drugs which were for more than 30 days’ supply.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.

(Please see the specific details on action required at the end of this report)

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

 Dr Rosie Benneyworth BM BS BMedSci MRCGP                                                                             Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derwent Medical Centre on the 16th March 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.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This was a follow up inspection to check compliance with regulations relating to cleanliness and infection control. When we inspected on 25 September 2013, the provider did not have an infection control policy in place or procedures outlining staff roles and responsibilities. We also saw that infection control audits and staff training had not taken place in the last 12 months. Our concern was that there were no effective systems in place to assess the risk of, and to prevent, detect and control the spread of health care associated infections. We asked the provider to take action.

When we inspected again on 20 March 2014, we saw that an infection control policy had been introduced and that the provider was undertaking regular infection control audits. We also saw that staff had attended infection control training. These measures meant that patients were protected from the risk of infection because appropriate guidance had been followed.

Patients expressed their views and were involved in making decisions about their care and treatment. We spoke with eight patients who used the service. They told us that they felt able to openly discuss the reason for their visit with the GP or nurse and that they were given sufficient information on any treatment required. One patient told us "I got all the advice from the doctor I needed." Whilst another patient told us "(the doctor) explained everything to me very well.”

Patients spoken with confirmed that they had been able to make an appointment to see their GP or nurse without any problems.

Care and treatment was planned and delivered in a way that was intended to ensure patient's safety and welfare. Assessments of patients' needs were undertaken and recorded. A patient told us "they have been caring and sensitive. They are very empathetic and get to know their patients.”

Medicines were prescribed appropriately. A patient told us "the doctor explains the medication along with the possible side effects" and "they check it wouldn’t interfere with my other medications."

Patients we spoke with told us that the practice was clean and tidy. One patient described the practice as “a nice environment". There had been no recent infection control audits or risk assessments for over a year. This meant that there was no effective system in place to assess the risk of and to prevent, detect and control the spread of a health care associated infection.