Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 4 November 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 12(1)(2)(a)(b)(c)(f) Safe care and treatment and regulation 17(1)(2)(a) Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this announced focussed inspection on 21 June 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Mitcham Family Practice on our website at www.cqc.org.uk.

Overall the practice is rated as good. Specifically, following the focussed inspection we found the practice to be good for providing safe services but they remained as requires improvement for well-led services. As the practice was now found to be providing good services for safety, this affected the ratings for the population groups we inspect against. Therefore, it was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students) and people experiencing poor mental health (including people with dementia). The practice was previously rated as requires improvement for effective, caring, responsive and well-led services for people whose circumstances make them vulnerable. Although the practice is rated as good for safety, the rating for this population group remains as requires improvement.

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

• Risks to patients were assessed and well-managed, including those related to responding to emergencies.
• Systems had been established so that outcomes of complaints and audits were acted and monitored to drive improvements in quality of the service.

However there were areas of practice where the provider should make improvements:

• Continue to develop the practice’s system to ensure adequate learning and development of the service from significant events.
• Review the practice’s defibrillator risk assessment to ensure a full review of risks and control measures are included.
• Continue to carry out clinical audits and develop a clinical audit plan for the practice.
• Ensure issues with the partnership are resolved so they have the capacity to deliver all the improvements identified.

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 Mitcham Family Practice on 4 November 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, it was not always clear if the practice acted on and monitored significant events and incidents effectively.
• Most risks to patients were assessed and well managed, with the exception of those relating to medical emergencies.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Data showed patient outcomes were average or above for the locality. Although some audits had been carried out, there was minimal evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a named GP and that 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.
• Information about services was available but not everybody would be able to understand or access it.
• Information about services and how to complain was available but the complaints process was not clear for patients.
• The practice had a number of policies and procedures to govern activity and support staff.
• The practice had proactively sought feedback from patients and had an active patient participation group.
• Although staff felt supported by the partners and management, there was evidence of conflict within the partnership which affected communication and decision-making in the practice.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure that the practice has systems in place to be able to appropriately respond to emergencies: specifically basic life support training for all staff, access to a defibrillator or adequate assessment and mitigation of risk and the availability of emergency medicines in line with recommended guidance.
• Ensure that the practice has governance systems in place to ensure that outcomes of incidents, complaints and audits are acted on and monitored to drive improvements in the quality of the service.

In addition the provider should:

• Carry out clinical audits including re-audits to ensure improvements have been achieved.
• Ensure that clinical staff are aware of their responsibilities in relation to the Mental Capacity Act.
• Ensure that multi-disciplinary meeting minutes are used effectively to monitor and improve patient outcomes.
• Provide information for patients to direct them to support services available to cope emotionally with care and treatment, including support for carers and families who have suffered a bereavement.
• Ensure the practice is able to identify patients acting as carers.
• Ensure there is effective communication to ensure that the partnership has the capacity to deliver all improvements identified.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice