Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Drive Medical Centre on 9 August 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 and lessons were shared to make sure action was taken to improve safety in the practice, however this was not always clearly recorded.

• 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.

• Performance for diabetes-related indicators was comparable to the local and national average for 2014/15, with some indicators below average; however, the practice demonstrated improvement in these areas for 2015/16.

• 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, however the practice did not keep a log of verbal complaints and comments to identify trends and areas for improvement.
• 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.
• Access to the service, particularly on the telephone, was highlighted as an issue; however, the practice had put in place measures to improve access.
• 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:

• The practice should continue to monitor, evaluate and improve performance in diabetes care.

• The practice should consider how to better record the analysis of significant events, including how learning is recorded and shared.

• The practice should consider a system for recording verbal complaints and feedback in order to identify trends and make improvements to services.

• The practice should continue to monitor, evaluate and improve access to services.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

People we spoke with who used the service told us they were happy with the surgery and its staff, whom one person called “a good team”. One person told us they thought the new triage service for appointments was “very good” and that they always received appropriate advice.

We observed that despite being very busy on the day of our inspection, reception staff were available to assist people in a timely manner, and were professional and polite. We found that when we sat in the reception area, we could not hear what was said as people checked in for their appointments. We also could not hear what was said when reception staff were on the phone.

We found that there were appropriate infection control measures in use at the practice and that medicines were adequately managed. We also found that people were protected from the risk of abuse because procedures were in place at the practice for safeguarding children and vulnerable adults, and staff demonstrated that they were aware of these procedures.