Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Green Man Medical Centre on 17 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report published in January 2017 can be found by selecting the ‘all reports’ link for Green Man Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 July 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 17 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety, including a fire risk assessment and regular alarm testing and fire drill as well as an infection control audit and a legionella assessment.
• All staff members had completed training relevant to their role including safeguarding and chaperone training and there was a system in place for ensuring staff members remained up to date.
• All staff members had received the appropriate checks through the disclosure and barring service (DBS).
• The practice had identified 61 patients as carers (1% of registered patients).
• Information about services and how to complain was available and the practice regularly held health promotion days. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had established a patient participation group that met every three months.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

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 The Green Man Medical Centre on 27 July 2016. Overall the practice is rated as requires improvement.

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

• Risks to patients were assessed but not well managed. Chaperone training had not been carried out by receptionists/administration staff who acted as a chaperone; there was also no risk assessment to mitigate risks against them not having a DBS check, although we saw that these had been applied for.
• There had been no infection control audit since 2013 and there was no action plan in place or evidence that actions had been completed. A legionella risk assessment had been carried out but ongoing actions as a result had not been carried out.
• There was no system in place for the routine checking of emergency equipment to ensure that it was in good working order.
• The practice did not have an active patient participation group as a means of gathering patient feedback.
• Data showed patient outcomes were comparable to the national average.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about services was available and easy to understand.
• The practice had a number of policies and procedures to govern activity.
• The provider was aware of and complied with the requirements of the duty of candour.
• 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.
• 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 areas where the provider must make improvements are:

• Mitigate risks associated with not complying with the actions identified in the legionella risk assessment and infection control audit.

• Review the system for checking that emergency equipment is in good working order.

In addition the provider should:

• Ensure quality assurance and improvement systems are developed to improve patient outcomes and mitigate identified risk.

• Continue to work to increase the number of patient carers on the practice list to ensure information, advice and support is available to them.

• Ensure that staff members that act as a chaperone have a DBS check or risk assessment and are trained for the role.
• Continue to work to establish a patient participation group to gather feedback about practice services from patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice