Letter from the Chief Inspector of General Practice

Heathview Medical Practice was formed following a merger between Dr Faisal Yunas and Anchor Medical Centre in November 2015. In November 2016, there was a second merger which saw Heathview Medical Centre merge with Dosthill Surgery.

We previously carried out an announced comprehensive inspection of Dr Faisal Yunas on 7 March 2016 (at the time of inspection, the registration process with the Care Quality Commission (CQC) to change the name to Heathview Medical Practice had not been completed). The practice was rated as requires improvement for providing safe services and good for providing effective, caring, responsive and well led services. The inspection report can be found by selecting the ‘all reports’ link for Dr Faisal Yunas on our website at www.cqc.org.uk.

We previously carried out an announced comprehensive inspection of Dosthill Surgery on 28 September 2015; we found three breaches of legal requirements. As a result, we issued two warning notices in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safe care and treatment.

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Good governance.

We also issued a requirement notice in relation to:

• Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Fit and proper persons employed.

We undertook an unannounced focussed inspection on 17 March 2016 to follow up on the warning notices. Further concerns were identified and the practice was required to complete an urgent response to demonstrate that these concerns had been addressed. A weekly report was sent to the CQC between 17 March 2016 and 23 May 2016 to demonstrate that improvements have been sustained. We undertook another announced comprehensive inspection on 23 May 2016 to check that the practice now met legal requirements. The practice was rated as requires improvement in safe, effective, caring and responsive, and inadequate in well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dosthill surgery on our website at www.cqc.org.uk.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We undertook a further announced comprehensive inspection of Heathview Medical Practice on 3 May 2017 to check that action had been taken to comply with legal requirements relating to providing safe and well led services. Overall the practice is now 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 there had been significant improvements in reporting and recording significant events.
• The practice had clearly defined systems to minimise risks to patient safety.
• Staff were aware of and seen to be providing treatment in line with current evidence based guidance.
• Clinical staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The provider had a training programme that included all staff. We saw that training requirements had been completed or planned.
• Results from the national GP patient survey published in July 2016 for both Heathview Medical Practice and Dosthill Surgery showed below average scores when patients were asked if they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. Verbal complaints were recorded but not collated therefore missed opportunities to further improve care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff spoke positively about the support from the new management team. Leadership within the nursing team was being addressed at the time of the inspection.
• 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.

The areas where the provider should make improvement are:

• Review the system for managing alerts to include a check that appropriate action has been taken.
• Implement systems to record verbal complaints so that trends can be identified.
• Add alerts to the records of the parents and siblings of children with a child protection plan in place.
• Consider role-specific training for the infection prevention control leads.
• Implement effective systems to ensure items such as syringes, dressings and dressing packs are in date.
• Ensure that fridges used to store medicines can provide data for the minimum and maximum temperatures.
• Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
• Implement a cohesive system for following up non-attenders for cancer screening.
• Review the availability of protected learning time available to allow for members of staff to complete training.
• Explore how the patient feedback can be improved, most notably in response to the consultations with GPs.
• Review the process for recording verbal complaints to allow trends to be identified and actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice