Letter from the Chief Inspector of General Practice

Gloucester City Health Centre is a city centre practice providing primary care services to patients resident in Gloucester. The practice has a patient population of approximately 8,000.

We undertook a comprehensive announced inspection on 7 January 2015. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector, a nurse specialist advisor and a GP specialist advisor.

Before visiting, we reviewed a range of information we held about the practice and asked other organisations to share what they knew. This included the Gloucester Clinical Commissioning Group (CCG), NHS England and Healthwatch Gloucester.

The overall rating for Gloucester City Health Centre is good. Our key findings were as follows:

• Patients were able to get an appointment when they needed it.
• Staff were caring and treated patients with kindness and respect.
• Staff explained and involved patients in treatment decisions.
• Patients were cared for in an environment which was clean and reflected good infection control practices.
• Patients were protected from the risks of unsafe medicine management procedures.
• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• The practice met nationally recognised quality standards for improving patient care and maintaining quality.
• The practice had systems to identify, monitor and evaluate risks to patients.
• Patients were treated by suitably qualified staff.
• GPs and nursing staff followed national guidance in the care and treatment provided.

We saw several areas of outstanding practice including:

• A GP triage system for patients who require urgent care which offered a medical consultation to all patients who contacted the practice and enabled patients to receive the most appropriate treatment.
• We were told that special arrangements had been put into place by the practice for dealing with the expected death of a member of the local Muslim community which allowed for an immediate funeral.
• Patients who had difficulty attending the practice were routinely visited by the practice nurses who undertook monitoring tests such as the International Normalised Ratio test which is a standardised method of reporting the effects of an oral anticoagulant on blood clotting.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

All patients we met at Gloucester City Health Centre spoke positively about the treatment and support they had been given. One person told us “all the doctors I have seen have been great – very accommodating”. Staff told us how they tried to make sure people got the right care for them.

Patients told us they were listened to, had enough information and had their dignity maintained. One patient told us that the doctors and nurses “talk to you and let you feel in control. I feel listened to”. One comment in the practice satisfaction survey was “[Nurse] is simply the best; she gives me plenty of time to prepare and is excellent at explaining what medication I got to carry on with”.

The practice building was safe and clean. Staff and patients told us the reception area was not welcoming but they did not feel this impacted on the standard of care. There was a lack of confidentiality in the reception area.

Almost all staff had received training on child safeguarding. Training around the Mental Capacity Act 2005 and adult safeguarding were yet to be completed. A policy was in place for child safeguarding and was being developed for adults. Some staff wanted more opportunity to discuss safeguarding as a practice team.

The practice used complaints, incidents, surveys and audits to improve patient experience. Patients we spoke with felt able to complain but some were unaware of the process in place. The results of the last satisfaction survey were generally positive.

This practice is rated as Good overall. (Previous rating January 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

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 Gloucester City Health Centre -WG on 30 May 2018 as part of our inspection programme.

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.
• The practice worked closely with local organisations representatives of the local Muslim community to improve services for asylum seekers and patients of the Muslim faith.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review the appointment system to improve patients’ experience of making an appointment.
• Identify and implement actions to improve uptake for the cervical screening programme, childhood immunisation and reviews for patients with long term conditions.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.