Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Freuchen Medical Centre on 1 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Freuchen Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 August 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 in our previous inspection on 1 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had made improvements in respect of the arrangements to respond to emergencies and major incidents.

• Data from the Quality and Outcomes Framework showed patient outcomes had improved since our previous inspection.

• There was evidence that appraisals and personal development plans had been implemented for all staff.

• Information had been displayed in languages appropriate for the local community and translation services were advertised in the patient waiting room. Facilities had been updated to meet the needs of mothers, babies and those patients who are hard of hearing and privacy curtains were available in all consultation rooms.

• The practice had drawn up an action plan to improve patient satisfaction with the service.

The areas of practice where the provider needs to make further improvements are:

The provider should:

• Continue to improve cervical screening uptake and childhood immunisation rates to bring them in line with local and national averages.

• Continue to monitor and act on feedback from patients.

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 Freuchen Medical Centre on 1 November 2016. Overall the practice is rated as requires improvement.

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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment, although mandatory training was not in all cases up-to-date.
• Not all staff felt supported with appraisals and personal development plans.

• Patient outcomes were below the national average including the management of long-term conditions, uptake for the cervical screening programme and childhood immunisations.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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. However, patients reported they had to wait a long time after their appointment time to be seen.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.

• There was a clear leadership structure however not all staff felt supported by management. The practice proactively sought feedback from patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure all clinical and non-clinical staff receive annual basic life support training and update the emergency medicines kit to include Atropine (used for the management of a slow heart rate which can occur during intrauterine contraceptive device fitting).

• Improve performance in relation to cervical screening and childhood immunisation uptake to bring in line with local and national averages.

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In addition the provider should:

• Continue to improve performance in relation to the management of long-term conditions.

• Provide information in languages appropriate for the local community and advertise translation services in the patient waiting area.
• Provide facilities to meet the needs of mothers, babies and those patients who are hard of hearing and provide privacy curtains in all consultation rooms.
• Ensure all staff are supported including appraisals and personal development plans.
• Consider ways to improve national GP patient survey results for caring indicators to bring 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

Freuchen Medical Centre is a GP practice which provides primary medical care including minor surgery to over 6000 patients in the Harlesden area of west London.

We carried out an announced comprehensive inspection on 22 October 2014. The inspection took place over one day and the inspection team comprised a CQC Lead Inspector and a GP.

The practice was rated as good in the area of responsive and requires improvement in the areas of safe, effective, caring and well-led. This gave an overall rating of requiring improvement.

Our key findings were as follows:

• safe systems were in place to monitor and manage individual patient care and safety
• care was planned and delivered effectively and patients underwent regular monitoring and medicines reviews
• patients reported that they felt listened to and involved in decision making.
• staff worked well with multidisciplinary teams to coordinate care for patients
• patients were generally satisfied with the ease of getting through on the phone and the opening hours at the practice.
• the practice was responsive to patient’s needs and acted on feedback from them to improve the service

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

Importantly, the provider must:

• carry out infection control audits on a regular basis to ensure that infection prevention and control systems to prevent, detect and control the spread of a healthcare associated infection are effective

The provider should:

• share information on performance monitoring with staff in whole practice meetings
• undertake a system of regular clinical and practice management audits and complete audit cycles to enable staff to regularly assess and monitor the quality of the services provided
• improve uptake rates for cervical screening and immunisations for under five year olds
• improve levels of patient satisfaction with respect to care and treatment
• carry out a legionella risk assessment

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice