This practice is rated as requires improvement overall. The practice was previously inspected on 21 November 2017. At that inspection the rating for the practice was requires improvement overall.

The key questions are rated as:

Are services safe? – good

Are services effective? – requires improvement

Are services caring? – good

Are services responsive? – good

Are services well-led? - requires improvement

We carried out an announced comprehensive inspection at Plumbridge Medical Centre to follow up on breaches of regulations identified during the inspection carried out on 21 November 2017. The inspection was carried out across two days by prior arrangement to accommodate staff leave.

At this inspection we found:

• The practice had some systems to manage risk, but these were not always applied consistently.
• In many areas, the practice was in line with local and national averages for clinical performance. However, in some areas they were not in line with local and national averages. For example, the practice was above the national and local average for their prescribing of hypnotics. In addition, they were below the national and local average in one of the diabetes management indicators.
• We saw evidence that care and treatment had not always been delivered according to evidence-based guidelines.
• When incidents happened, the practice had not always learned from them and improved their processes.
• There was a lack of governance arrangements to ensure that risk was managed and that quality assurance processes were in place to improve patient outcomes.
• The practice had identified 73 patients as carers (3% of the practice list).
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Feedback from patients on the day of the inspection indicated that staff treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was limited focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• The practice must ensure systems and processes are established and operated effectively to demonstrate good governance.

The areas where the provider

should

make improvements are:

• Take action to increase the uptake of childhood immunisations and cervical screening.
• Review the information available to patients about how to make a complaint.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Plumbridge Medical Centre on 27 January 2016. The overall rating for the practice was good. The full report of this inspection can be found by selecting the ‘all reports’ link for Plumbridge Medical Centre on our website at www.cqc.org.uk.

On 27 September 2017 a second announced comprehensive inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was still meeting the legal requirements of the regulations. Overall the practice is now rated as requires improvement.

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

• Staff understood their responsibilities to raise concerns and to report incidents and near misses. However, not all staff were aware of the correct documentation to use for reporting incidents.
• Risks to patients were not always well managed, such as those relating to recruitment checks; infection control; fire drills; monitoring of emergency equipment and medicines and the management of patient safety alerts.
• Staff had not received an appraisal in the preceding 12 months.
• Not all staff acting as chaperones had been trained for the role or received a Disclosure and Barring Service (DBS) check.
• Patient Group Directions were out of date and had not been signed by the current practice nurse.
• The cold chain policy was not adequate and there was insufficient monitoring of the cold chain procedures within the practice.
• We saw no evidence that clinical audits were driving improvements to patient outcomes.
• The practice had a number of policies and procedures to govern activity but not all included a review date.
• Not all staff had received training in infection control, fire safety, safeguarding and information governance relevant to their role.
• The practice had identified only six patients as carers (0.2% of the practice list).
• Patients we spoke with said they found it easy to make an appointment with a GP and were treated with compassion, dignity and respect.
• National GP Patient survey satisfaction rates were above or comparable to local and national averages for all indicators.
• Quality performance data showed patient outcomes were comparable to the local and national averages.

The provider must ensure care and treatment are provided in a safe way for service users. There were areas where the provider must make improvements:

• The provider must ensure there is a safe and effective cold chain procedure in place and monitor that this is followed by all staff.
• The provider must ensure that a process is in place to ensure results are received for all cervical screening samples sent for testing.
• The provider must ensure that all necessary employment checks are carried out for all staff.
• The provider must ensure that a programme of annual appraisals for all staff is implemented.
• The provider must ensure that patient group directions are in date and signed by all relevant personnel.
• The provider must ensure that all staff undertaking chaperone duties are trained for the role and have received a Disclosure and Barring Service (DBS) check.
• The provider must ensure that there is an appropriate procedure in place following the receipt of patient safety alerts, such as those produced by the Medicines and Healthcare products Regulatory Agency (MHRA).

• The provider must provide staff with the opportunity to undertake training appropriate to their role.

There were also areas where the provider should make improvements:

• The provider should develop and implement an appropriate clinical audit programme to identify and implement necessary improvements to patient care.
• The provider should implement an effective process for regular checking of emergency equipment and medicines.
• The provider should develop strategies to encourage patients to join the patient participation group (PPG) and establish regular communication with group members.
• The provider should continue to work towards increasing the immunisation uptake rates for all standard childhood immunisations.
• The provider should continue to actively encourage patients to participate in national screening programmes.
• The provider should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to all carers registered with the practice.
• The provider should carry out regular staff meetings.
• The provider should carry out regular infection control audits and fire drills.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice