Letter from the Chief Inspector of General Practice

This practice is rated as Requires improvement overall. (Previous inspection 26/08/2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) – Requires improvement

We carried out an announced inspection at Mayfield Medical Centre on 23 March 2018 as part of our inspection programme.

At this inspection we found:

• Some risks to patients were assessed and well managed. When incidents did happen, the practice learned from them and improved their processes.
• However, patients were potentially at risk of harm because systems relating to emergency medicines and equipment were not fully effective to keep patients safe.
• Recruitment checks were not managed effectively in line with the practice policy and regulations. Health and safety assessments did not fully minimise risks.

• Arrangements relating to health and safety were not managed effectively.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Data showed patient outcomes were mostly in line with or above the local and national averages for most indicators. However, cancer screening rates were below local and national averages.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Feedback from patients we spoke with during our inspection was highly positive about the caring approach of all staff.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice understood the needs of its population and tailored services in response to those needs.
• The practice had a number of policies and procedures to govern activity, but some of these needed to be reviewed to ensure they contained up to date information.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Consider annual reviews of significant events to facilitate trend analysis of the issues recorded.
• Establish a system for logging safety alerts received to assure themselves how these have been acted on.
• Strengthen the system for managing staff training to ensure all training considered mandatory is undertaken and up to date.
• Update the complaints leaflet for patients with up to date signposting information.
• Strengthen ways in which the service seeks and acts on patients’ views in regards to the care and treatment provided through engaging with more patient participation group members.
• Review processes in place to improve uptake rates for national screening programmes.

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 focused inspection at Dr Yella Sambasivarao practice on 26 August 2015. This was to check that improvements had been made to meet legal requirements following our comprehensive inspection on 17 November 2014.

Overall the practice is rated as good. Our key findings across the areas we inspected were as follows:

• Appropriate standards of cleanliness and hygiene were followed.
• A robust system was in place for identifying, recording and learning from safety incidents and significant events. 
• Systems were in place to keep patients safe and to protect them from harm. Staff recruitment, infection control and chaperone procedures had been strengthened.
• Appropriate emergency equipment and medicines were available to deal with emergencies.
• The systems for ensuring that patients were referred promptly to other services had been strengthened.
• Clinical audits were used to improve the outcomes for patients, and provide assurances as to the quality of care.
• Minor surgery was delivered in line with current best practice, and the practice had obtained approval from NHS England to carry out such procedures.
• All staff had received recent training on the Mental Capacity Act (2005) to ensure they understood the principles of the act and the safeguards.
• Further systems had been put in place to drive improvements and to monitor the quality of services provided. 
• A robust appraisal system had been put in place to support the learning and development needs of staff.

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

Importantly the provider should :

Further strengthen ways in which the service seeks and acts on patients’ views in regards to the care and treatment provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected this practice on 17 November 2014, as part of our new comprehensive inspection programme. The practice had not previously been inspected.

The overall rating for this service is requires improvement. The practice was rated as good in caring and responsive domains but requires improvement in safe, effective and well-led domains. The concerns which led to these ratings apply to everyone using the practice. The population groups were therefore rated as requires improvement.

Our key findings were as follows:

• Patients expressed high levels of satisfaction with the care and service they received.
• The practice had an experienced and established staff team who were committed to meeting patients’ diverse needs.
• Patients were treated with kindness, dignity and respect.
• The practice was open and transparent when things went wrong. Although, a robust system was not in place for identifying and learning from safety incidents and significant events.
• Systems were generally in place to keep patients safe and to protect them from harm. However, robust procedures were not followed in respect of staff recruitment, infection control and chaperone duties.
• The appointment system was flexible, and enabled patients to access care and treatment when they needed it.  A few patients reported difficulty at times in getting to see the GP.
• The systems for ensuring that patients were referred promptly to other services required strengthening.
• Not all clinical audits were used effectively to improve the outcomes for patients, and provide assurances as to the quality of care.
• The staff team were committed to improving the services for patients. Staff felt valued, supported, and involved in decisions about the practice. However, records were not available to show that all staff had received appropriate training and appraisal to carry out their work effectively.
• We highlighted areas where robust systems were not in place to drive improvements and monitor the quality of service. Arrangements were not in place to regularly seek patients’ views in relation to the care and treatment provided.

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

Importantly, the provider must:

Ensure the information required by law is available in regards to staff employed to work at the practice.

Regularly seek patients’ views in relation to the care and treatment provided, and have effective systems in place to assess and quality of services. To include recruitment procedures, infection control, clinical audit and minor surgery.

Ensure that all staff receive appropriate training, supervision and an appraisal.

Keep appropriate records in relation to the management of the regulated activities. To include staff training and appraisals, checks to ensure nurses and GPs remain registered to practice and staff immunity from Hepatitis B infection.

In addition the provider should:

• Ensure effective systems are in place for:

Identifying, recording and learning from safety incidents and significant events.

Referring patients promptly to other services.

Reviewing the appointment system and telephone response times to ensure it meets patients’ needs.

• Carry out a Legionella risk assessment to identify possible risks in the water system, and measures that need to be in place to minimise the risks.

• Ensure all staff are competent to undertake their roles by;

Developing the induction programme to include sufficient information, which is relevant to specific staff roles.

Providing training for all staff on the Mental Capacity Act 2005, to ensure they understand the principles of the Act and the safeguards.

Providing training for relevant staff to enable them to carry out chaperone duties effectively.

Completing a robust appraisal and review of their learning and development needs.

• Ensure that arrangements are in place to enable people whose first language is not English, to access information about services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice