This practice is rated as Good overall. (Previous rating November 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Gladstone Medical Centre - M Salahuddin on 6 November 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage safety incidents, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence based guidelines, although there was no formal method for implementation and monitoring of these guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient told us that sometimes it was difficult to get through by telephone to make appointments. The practice was monitoring this and implementing a new telephone system. Appointments were available with different clinicians and urgent/same day appointments were always available.
• There was a clear leadership structure and staff felt supported by management.
• The practice reviewed and considered patient views through surveys and a patient participation group (PPG).
• Staff worked well together as a team and all felt supported to carry out their roles.
• The provider was aware of the requirements of the duty of candour.
• All complaints were reported and analysed, however the policies and procedures in place were not always followed.
• The practice did not have effective systems in place to mitigate safety risks including management of medicines, storage of historic paper medical records, infection control and dealing with safeguarding.
• The practice had adequate facilities and was equipped to treat patients and meet their needs, however some areas of the premises were in need of renewal/refurbishment in order to safely maintain effective infection prevention and control throughout.

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

• Ensure care and treatment is provided in a safe way to patients
• Ensure patients are protected from abuse and improper treatment
• Maintain appropriate standards of hygiene for premises and equipment.

The areas where the provider should make improvements are:

• Review the availability of medicines in the practice to manage medical emergencies considering the guidelines issued by the British National Formulary and the General Medical Council.
• Review the system for implementation of National Institute for Health and Care Excellence guidelines.
• Review the need for training of staff and awareness of guidance for sepsis.
• Review the system for responding to complaints by patients and other persons to ensure all communication is documented and complaints are responded to in a timely manner.
• Review the system for maintaining an audit trail for printer prescription pads.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gladstone Medical Centre on 11 February 2016. The overall rating for the practice was inadequate with ratings of inadequate for providing safe, effective, caring and well led services and requires improvement for providing responsive services and the practice was placed in special measures for a period of six months. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Gladstone Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 3 November 2016. Overall the practice is now rated as good and rated as good for providing safe, effective, responsive and well led services but requires improvement in providing caring services.

Our key findings were:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice partners were now working together to support and maintain the changes made at the practice.

• Risks to patients were assessed and well managed.

• An improved recruitment process had been implemented since our last inspection and this had been followed when recruiting new staff.

• An improved safeguarding system and process had been implemented since our last inspection and this had resulted in effective monitoring of vulnerable children and adults.

• An improved medicines management system had been implemented since our last inspection and this had resulted in patients receiving effective safe care and treatment.

• Regular clinical meeting took place as part of the practice’s improvement agenda to improve patient outcomes.

• There were systems in place to ensure lessons were learnt from complaints and actions were clearly recorded and monitored.

• The practice had a system in place to ensure safety alerts and best practice guidance was disseminated across the practice team.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their treatment. Patients were positive about their interactions with staff.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There were systems in place to ensure test results were followed up as a result of abnormal results.

• The practice had arrangements in place to deal with emergencies and major incidents.

• The national GP patient survey showed the practice performed worse than local and national averages for consultations with GPs and nurses. The last three national patient survey results showed a downward trend with regard to the practice’s performance in relation to patients’ experiences of consultations with GPs and Nurses. However, this data was collected before our first visit in February 2016 and no further data was available at the time of our second inspection. The practice had begun to take steps to investigate the cause of the low satisfaction rates but this had yet to be fully completed.

The areas where the provider must make improvements are:

• Continue to review and address issues raised in the national patient survey to assure themselves that improvements that have already been made are sustained and have had a positive impact.

In addition the provider should:

• Regularly review recent improvements and consider how the practice can ensure the sustainability of these improvements.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by the service.

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 Gladstone Medical Centre on the 11 February 2016. Overall the practice is rated as inadequate. The practice is rated inadequate for providing safe, effective caring and well led services and requires improvement for providing responsive services.

Our key findings were as follows:

• There was a lack of systems in place to safeguard children and vulnerable adults from abuse.
• Recruitment systems did not protect patients from receiving inappropriate care and treatment.
• There was a lack of overview of the infection control systems at the practice.
• The practice did not have a system in place to securely store and audit the use of prescription pads. Non-clinical staff were adding medication changes to patient records following receipt of hospital letters. There was no evidence that clinicians had reviewed and assessed the medication changes and were responsible for the reauthorisation process.
• There were no systems in place to share learning from significant events to promote service improvement and safety.
• Regular clinical and team meetings did not take place as part of an improvement agenda to improve patients’ outcomes.
• The practice did not have a system in place that monitored best practice guidelines and guidelines were not followed through risk assessments, audits and random sample checks of patient records.
• There was no system in place to ensure lessons were learnt from complaints and that action was taken including an open and transparent response to patients.
• The national GP patient survey showed the practice performed worse than local and national averages for consultations with GPs and nurses. The last two national patient survey results show a downward trend with regard to the practice’s performance in relation to patients experiences with consultations with GPs and Nurses.
• There were systems in place to ensure results were received for all samples sent for the cervical screening programme and the practice followed up women who were referred as a result of abnormal results.
• The practice had arrangements in place to deal with emergencies and major incidents
• Patients were positive about their interactions with both clinical and non-clinical staff and said they were treated with compassion and dignity.

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

Importantly, the provider must:

• Develop appropriate procedures for recording, acting on and monitoring significant events, incidents and near misses. Ensure that all incidents are fully investigated and any learning from these is applied and shared with all staff.

• The practice must ensure that learning from complaints is shared with staff and any changes to working practices as a result of learning are implemented.

• Take action to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held securely and can be produced when required. All policies in relation to recruitment must be updated to reflect current legislation.

• Develop appropriate procedures for the safe management of medications and storage of prescriptions.

• Ensure suitable arrangements are in place to safeguard vulnerable adults and children from abuse.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. Including the implementation of regular clinical and non-clinical meetings, the use of clinical and non- clinical audits and patient survey results to drive improvement in the practice.

On the basis of the ratings given to this practice at this inspection, I am placing the service into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients told us they were generally satisfied with the service provided at the practice. Comments made included:

“I feel the service provided is good”,

“They have a very good wide range of services that they provide”.

We found that there were suitable systems in place to gain consent from the patients. Formal documented consent was obtained for surgical procedures and patients told us staff asked for their consent and permission when undertaking any examinations or procedures. Staff were knowledgeable in safeguarding of vulnerable adults and children and had received appropriate training.

We found that patients care and treatment was assessed, planned and delivered in order to meet their needs. Care and treatment plans were documented and reviewed and patients were given information and explanation regarding their care or treatment.

Staff were inducted and received training relevant to their roles. Annual appraisals were undertaken and documented.

We found the provider had systems in place for monitoring the quality of services. Audits and patient satisfaction surveys were undertaken. A patient participation group functioned within the practice and a member gave us positive feedback regarding the service and their relationship with the practice staff. The practice participated in the quality and outcomes framework system (QOF). This was used to monitor the quality of services provided.