Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Laburnum Health Centre on 18 October 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and 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 were able to make an appointment when they needed one, 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 areas where the provider should make improvement are:

• Consider keeping the full complement of emergency medicines in one central location that staff all have ready access to.
• Formalise the risk assessment supporting the decision not to take any medicines on home visits.
• Put systems in place to maintain a supply of oxygen masks and defibrillator pads for children at the practice.
• Consider further ways of meeting the needs of patients with long term conditions given the high exception reporting rates compared to local and national averages.
• Consider further ways of improving the uptake of cervical screening given the high exception reporting rate compared to local and national averages.
• Review arrangements for the identification and support of carers amongst the practice patient list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We did not speak to patients on this occasion. At our previous inspection on 25 April 2014, we were concerned that privacy and dignity was not always maintained in the reception area. We were also concerned about the management of patients on Methotrexate and found that complaints were not always handled in a timely manner.

On this visit, we observed staff patient interaction within the reception area and found that confidentiality was maintained. Posters had been put up to ensure that people could request for a private room to discuss confidential issues. There had been three complaints since our last visit. All three had been acknowledged and responded to in a timely manner. Staff showed us the way they managed patients on methotrexate, this was done by checking that blood tests had been completed before issuing repeat prescriptions

We spoke to 11 patients, collected 12 response cards and reviewed comments made by patients in a local survey. We spoke to patients with chronic conditions such as asthma, diabetes and some who were on warfarin. They told us that the nurses were good at explaining things at their check -up. One person said “the warfarin clinic is very good." Another said “staff are helpful. They always try to help especially with explaining why I need to take all my tablets."

We found that there was information displayed relating to opening times and other health care conditions. We observed staff at reception and noted instances where confidentiality of patients was not always maintained.

We spoke to clinical staff who told us how they accessed, referred and ordered further investigations such as scans using an electronic patient record system. We looked at 12 patient consultation records and found that staff consistently assessed and recorded treatment, and advice given.

We found that medications were stored and handled appropriately. The electronic prescription service was working well and there was an established warfarin clinic.

Clinical and non -clinical staff told us they worked well with other professionals such as the district nurse and palliative care nurse. We saw minutes and action plans which verified that joint working meetings took place.

We found that the complaints system and the system for monitoring patients on methotrexate, needed to be improved.