Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S M Arolker and Partners on 16 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for all the population groups.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 difficult to make an appointment with a named GP but urgent appointments were available the same day.
• 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.

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

Importantly the provider should:

• Consider improved ways to deliver effective multi-disciplinary working in relation to safeguarding and palliative care patients.
• Ensure a whistleblowing policy is in place and that staff know how to access it.
• Ensure the defibrillator at Parker Drive is accessible to staff at all times.
• Ensure that reception staff know how to act appropriately when patients with urgent treatment needs contact the surgery, for example breathlessness.
• Ensure action plan for learning disability reviews is monitored through the practice meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Dr Arolker and partners provides primary medical services for a local population of approximately 15,000patients. A branch surgery is also provided at The Manor Medical Centre and the practice population is split between the two sites. We did not inspect the Manor Medical Centre branch surgery as part of this inspection.

We spoke with nine patients and reviewed fifteen completed comment cards. These had been completed by patients before the inspection and were used to gather information about the experiences of patients who used the service. We spoke with one local care home to find out what their views of the practice were. On the day of inspection we spoke with the chair of the patient participation group (PPG), three GPs and other staff including the practice manager from Parker Drive Medical Centre and the practice manager from the Manor Medical Centre, a practice nurse, health care assistant and administration staff. We observed how staff interacted with patients.

As part of the planning of this inspection, we looked at the data provided by the local Clinical Commissioning Group (CCG). During the inspection we looked at procedures and systems used and all of this information helped us to identify whether the practice was safe, effective, caring, responsive to people’s needs and well-led.

We noted that the practice serves predominantly a working age population. However we found that the practice responded to the needs of older people; people with long term conditions; mothers, babies, children and young people; the working age population; people in vulnerable circumstances; and, people who were experiencing poor mental health.

We found that although some systems were in place to ensure patients were safe, medication management systems were not all robust. There were no checks in place to ensure medication in GP’s bags was within its expiry date and available for use. Records to demonstrate that ‘cold chain’ had been maintained for travel vaccinations transported to the branch surgery were not available.

The inspection found that the practice was in breach of the regulations relating to:

Management of medicines

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.