This practice is rated as Good overall. (Previous inspection December 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services well-led? - Good

We carried out an announced focused inspection at Fullwell Cross Medical Centre on 2 May 2018. We undertook this inspection in response to concerns identified and brought to the attention of the commission. This was a focused inspection which looked at the Safe and Well-led key questions.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice changed how patients could access the practice by telephone to make booking appointments easier.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had an active patient participation group (PPG) which supported the practice in identifying and implementing improvements to the overall patient experience.

The areas where the provider should make improvements are:

• Ensure the implementation and review dates are clearly recorded on all practice policies and procedures.

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 Fullwell Cross Medical Centre on 14 December 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. However, the practice procedure for checking that results were received for all cervical smears sent for testing was not always adhered to. The practice informed us following the inspection that immediate action had been taken to implement a weekly audit to check that the procedure in place was adhered to.
• 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.
• 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.

• Patient statisfaction rates with regards to appointments was comparable with local and national averages in most areas.

• 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.

We saw one area of outstanding practice:

• The practice had identified that their elderly patient population was higher than the local average and in response the practice had introduced the post of Care of the Elderly Health Care Assistant (HCA). This was a Monday to Friday service (30 hours per week) providing home visits for urgent and routine assessments for elderly and housebound patients and patients receiving palliative care. The HCA was contactable via mobile phone by both patients and staff and was supported in this role by the GP lead for older patients.

The areas where the provider should make improvements are:

• The provider should continue to monitor patient satisfaction in relation to GP appointments and take action to improve the patient experience where appropriate.
• The provider should continue to monitor adherence to the procedure used to confirm that results are received for all cervical smears sent for testing.

Professor Steve Field  CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We spoke to members of the Patient Participation Group (PPG) and people visiting the surgery on the day of our inspection. During our previous inspection in August 2013 we found a number of people felt they were not always treated with dignity and respect by reception staff, it was difficult for people to obtain appointments and the Patient Participation Group (PPG) was not used effectively.

During this inspection we found that improvements had been made. People told us they were happy with the service provided by the medical staff at the practice. One person said “I don’t feel rushed I am happy here. Some doctors have more time for you”. Another person said “doctors do treat you with respect, they allow time to ask questions”. People told us the GPs were approachable and listened.

Most people we spoke with on the day of our inspection told us they had been able to make an appointment that day, at a time which suited them. Some people still had difficulty in making an appointment using the telephone system or getting an appointment with their preferred GP or nurse. People we spoke with had positive views about the reception staff at the practice and said they were helpful and respected their privacy. The Patient Participation Group felt involved in improvements at the centre.

We spoke to members of the Patient Participation Group (PPG) and people visiting the surgery on the day of our inspection. People told us they were happy with the service provided by the medical staff at the practice. One person said “the doctors are really good and friendly”. Another person said “all the doctors are good, the nurse is terrific”. People told us the GPs were generally approachable, listened, and they could ask questions if they needed to.

Some people we spoke with on the day of our inspection told us they had been able to make an appointment which suited them on that day. However, the majority of people told us it was difficult firstly to get an appointment and secondly an appointment with a named GP, or nurse. People we spoke with had mixed views about the reception staff at the practice. Some people said they were very pleasant. Others told us that some reception staff could be ‘negative’ and sometimes rude. We also found that people's privacy and dignity was not respected in every case.

People's care was planned and delivered in a way that met their individual needs. We looked at four people's records regarding chronic disease planning, care and advice. There was evidence that a plan was discussed with patients and appropriate referrals made.

We found that people were protected from the risk of abuse because the provider had procedures in place for safeguarding vulnerable adults and children and medical staff we spoke with were aware of these procedures. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. There were adequate systems in place to assess and monitor the quality of service that people received.