Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Headstone Lane Medical Centre on 18 November 2016. The overall rating for the practice was good. However we rated the practice as requires improvement for providing a caring service and for the care provided to people with long term conditions.

More specifically, we found that the practice:

• scored below the local and national average for patient experience of consultations and involvement in decisions on the national GP patient survey in 2016
• was performing below the local and national average for its management of diabetes
• had lower than average uptake rates for cancer screening services
• had not fully embedded completed clinical audit cycles as a quality improvement tool.
• was not always implementing non-clinical safety alerts
• did not have systems to maintain full prescription security.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Velupillai Ravikumar on our website at www.cqc.org.uk.

This inspection was a focused inspection carried out on 8 December 2017 to confirm that the practice had made improvements since our last inspection.

Overall the practice is rated as good. We have also rated the practice as good for providing a caring service and for the care provided to people with long term conditions.

Our key findings were as follows:

• The practice results for the national GP patient survey had improved in 2017 and were comparable with the local and national averages. The practice had engaged with patients and taken action to improve the patient experience.
• The practice had improved its performance in managing diabetes and its results were comparable with local average on the relevant Quality and Outcomes Framework indicators. For example, in 2016/17, 71% of diabetic patients recorded blood sugar levels that were adequately controlled (that is, their last IFCC-HbA1c measurement was 64 mmol/mol or less) compared to the local Clinical Commissioning Group and national average of 80%. The practice exception reporting rate for this indicator was 3% compared to the national exception reporting rate of 12%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). The practice had taken action to improve its care in this area, for example doubling the number of sessions offered by the local specialist diabetic nurse at the practice.
• The practice had taken action to improve cervical screening uptake rates. The practice had identified that low uptake was more often associated with patients originating from Sri Lanka. The practice had assigned a member of the reception team to follow up women who did not respond to their invitation to attend for cervical screening. This member of staff could speak Tamil and was able to discuss the screening test in a culturally sensitive way. The practice had also engaged a locum nurse who was Tamil-speaking and displayed posters about the screening test in the waiting area in Tamil.
• The practice carried out completed clinical audit cycles as part of its quality improvement work. The practice demonstrated that audit was used to ensure that effective practice was being sustained. For example the practice had completed two-cycle audits focusing on the prescribing of methotrexate and warfarin (higher risk medicines); its cryotherapy service and the identification and management of "two week wait" cancer referrals.
• The practice provided evidence that it routinely circulated information about non-clinical safety alerts and acted on these when relevant.
• The practice had improved prescription security, for example by keeping a record of serial numbers and routinely tracking the use of prescription materials.

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 Headstone Lane Medical Centre on 18 November 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 a system in place for reporting and recording significant events. The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff were appropriately trained and qualified and had the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey were mixed. The practice consistently scored below average for the quality of consultations with clinical staff and for patient involvement in decision making. The receptionists were rated very highly for being helpful.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day and routine appointments available within 48 hours.
• 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 sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• The practice should aim to improve the management of diabetes among the practice population. The high prevalence of this condition means that improvement would have a significant beneficial impact on patients' long term health.
• The practice should consider ways to improve the cancer screening uptake rates among its population.
• The practice should consider improving the security of prescription materials, for example by maintaining a record of serial numbers.
• The practice should implement a system to identify, risk assess and if necessary, act on relevant non-clinical alerts, for example, securing looped blind cords.
• The practice should carry out more two-cycle audits to ensure that observed improvements are sustained in practice.

• The practice should investigate patient experience of its service. In particular it should explore ways it might improve patient satisfaction with the quality of consultations and patient involvement in decisions.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We spoke with five patients, two receptionists, a practice nurse, the business manager, practice manager and a GP. We also looked at comments from people on the NHS Choices website. Patients spoke highly about the quality of service they received. They told us they were treated with respect and were fully involved in decisions about their care and treatment. Comments from patients included “I’ve been coming here for years, it is a friendly atmosphere,” “The doctors speak my language which is nice,” and “I can get an appointment when I need one.”

Patients said their privacy and dignity were respected and staff were welcoming and approachable.

Patients received the care and treatment that they needed. The GPs arranged for diagnostic tests to be carried out and referred patients to other services or specialists when necessary. A patient commented “They refer me to hospital for tests when I need them.” Reviews of patient's care and treatment took place and these were recorded.

Arrangements were in place to ensure that appropriate action was taken in response to incidents or allegations of abuse. Staff were aware of the reporting and recording procedures that they needed to follow in response to allegations of abuse. Essential checks were undertaken before staff began work.

Patients had the opportunity to provide feedback about the service. The patients we spoke with confirmed that they would recommend the practice to other people.