Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Green Cedars Medical Services on 16 August 2016. The overall rating for the practice was good, however the effective domain was rated as requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Green Cedars Medical Services on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 August, 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 16 August, 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice rating remains as good, the practice is now rated good for providing effective services.

Our key findings were as follows:

• Exception reporting rates had decreased significantly since the inspection on 16 August 2016.Exception reporting is the removal of patients from quality and outcomes framework (QOF) calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.

• Clinical audits were used to drive improvement in patient outcomes.

• All staff at the practice completed fire safety training.

• All screens used in clinical rooms were visibly clean and were included on the daily cleaning schedule.

• Prescription pads were kept in a secure area and all serial numbers were recorded on a log maintained by the practice manager.

• Comprehensive infection control audits were completed two to three times per year.

• Carers were identified through new patient registration forms, posters in reception and clinical consultations. The number of carers identified was less than one percent of patients registered at the practice. The practice told us this was in relation to their young patient population. For example, the number of patients at the practice aged 60 years or older is significantly lower than the national average.

At our previous inspection on 16 August 2016, we rated the practice as requires improvement for providing effective services as exception reporting was much higher than local and national averages. At this inspection we found that the exception reporting rate had decreased significantly. The practice is now rated as good for providing effective services.

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 Green Cedars Medical Services on 16 August 2016. The overall rating for the practice was good, however the effective domain was rated as requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Green Cedars Medical Services on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 August, 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 16 August, 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice rating remains as good, the practice is now rated good for providing effective services.

Our key findings were as follows:

• Exception reporting rates had decreased significantly since the inspection on 16 August 2016.Exception reporting is the removal of patients from quality and outcomes framework (QOF) calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.

• Clinical audits were used to drive improvement in patient outcomes.

• All staff at the practice completed fire safety training.

• All screens used in clinical rooms were visibly clean and were included on the daily cleaning schedule.

• Prescription pads were kept in a secure area and all serial numbers were recorded on a log maintained by the practice manager.

• Comprehensive infection control audits were completed two to three times per year.

• Carers were identified through new patient registration forms, posters in reception and clinical consultations. The number of carers identified was less than one percent of patients registered at the practice. The practice told us this was in relation to their young patient population. For example, the number of patients at the practice aged 60 years or older is significantly lower than the national average.

At our previous inspection on 16 August 2016, we rated the practice as requires improvement for providing effective services as exception reporting was much higher than local and national averages. At this inspection we found that the exception reporting rate had decreased significantly. The practice is now rated as good for providing effective services.

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 Green Cedars Medical Centre on 16 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.

• Exception reporting at the practice was much higher than the local and national averages.

• 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.

• 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.

• 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.

The area where the provider MUST make improvements is:

• Review clinical exceptions for all long term conditions to ensure they meet the clinical criteria for exception reporting.

The areas where the provider SHOULD make improvements are:

• Ensure there are quality assurance systems for identifying improvements in clinical care including two cycle completed clinical audits.

• Ensure all staff complete fire training on an annual basis.

• Ensure screens in clinical rooms are added to the cleaning schedule.

• Review audit systems in relation to prescription pads.

• Ensure the action plan in the infection control audit has a clear timescale for completion of issues identified.

• Review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice