Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shadwell Medical Centre on 1 March 2016. The overall rating for the practice was requires improvement and the practice was asked to submit an action plan setting out how they would improve systems and processes within the practice and the date by which these improvement would be implemented. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Shadwell Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following confirmation from the practice that all actions were completed and was an announced comprehensive inspection on 17 January 2017. Overall the practice is now rated as Good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Feedback from patients about their care was consistently positive.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, reception staff had been supported with training in customer services.
• The practice had worked with the Leeds North Clinical Commissioning Group to implement a number of recommendations, such as improving the systems for monitoring of amber drugs and ensuring nursing staff had access to appropriate clinical supervision. Amber drugs are a list of medication which require initiation by a specialist within a hospital setting but can be transferred to primary care for ongoing use.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had visible clinical and managerial leadership and governance arrangements.

The areas where the provider should make improvements are:

• Continue to assure themselves that suitable medicines and healthcare products regulatory alerts (MHRA) protocol is implemented within practice to capture any patients who do not respond and follow up for action.
• Continue to maintain the newly implemented systems, processes and practices and ensure they are embedded into the culture of the practice.
• Set aside regular time for GPs within the practice to communicate and discuss topics such as NICE Guidance and Safety Alert Broadcasts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Our inspection on the 22nd May 2014 we found the practice had not ensured patients had sufficient access to appointments with the GPs. The practice had also not followed recruitment procedures or provided adequate support and guidance to staff. Following the inspection the practice wrote to us and told us they would take action to ensure they were compliant with these essential standards.

At this inspection we found that improvements had been made. The provider now reviewed patient’s access to appointments and put systems in place to ensure staff were recruited safely and had the right support and guidance in place.

We visited the practice because concerns had been raised with us. The main concern was that there were not enough GPs at the surgery. We were also told that it was difficult to get an appointment to see a GP and that the appointment system was inflexible.

We spoke with seven patients during our visit, the practice manager and clinical and administration staff. We saw three GPs had recently left and that the provider had put into place locum GPs to ensure clinical support was maintained. We also saw new GPs and nursing staff were being recruited. However we found there had been some stress on the appointment schedule during the time of this transition. We found staff recruitment was not robust. We also found supervision and appraisals were out of date and staff felt unsupported and unclear about their roles.

The practice had mechanisms in place to monitor and asses the standard of care patients received. However we did find the provider had failed to notify the Care Quality Commission of important changes to their registration.

We spoke with four patients, the registered provider (the lead GP), the practice manager, a health care assistant and a receptionist.

Patients' needs were assessed and care and treatment was planned and delivered in line with their individual wishes.

Staff had received training in the safeguarding vulnerable of adults and children. They were aware of the appropriate agencies to refer safeguarding concerns so patients were protected from harm.

Staff received appropriate professional development. The provider had worked continuously to maintain and improve high standards of care by creating an environment where clinical excellence could do well.

There were systems in place to gather the views of patients who used the service about the care and support provided. Patients had their comments and complaints listened to and acted on to improve the patient experience.

This practice is rated as Good overall. The practice was previously inspected on 17 January 2017 when it was rated good overall with a rating of requires improvement for providing safe services.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Shadwell Medical Centre on 17 April 2018. This was part of our inspection programme and also to follow up on areas identified for improvement during the previous inspection.

At this inspection we found:

• The practice had systems in place to manage risk so that safety incidents were less likely to happen.
• The practice had policies and protocols in place which were accessible to all staff.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. The practice had taken steps to proactively identify carers and had taken steps to engage with local services to train staff.
• The practice had made significant improvements with regard to patient satisfaction levels.
• The practice demonstrated positive outcomes in relation to management of pre-diabetic patients and amber drugs monitoring. This achievement had been acknowledged by the Clinical Commissioning Group (CCG).
• There was a strong focus on continuous learning and improvement; and the practice could clearly demonstrate where improvements had been made since the last Care Quality Commission inspection.

We saw areas of outstanding practice:

• The practice proactively identified carers by undertaking a reviewing of clinical coding and opportunistically asking patients to identify their carers. For example; during long term conditions reviews and frailty assessments. The practice had identified 644 patients as carers (13% of the practice list). Carers were offered an annual seasonal flu vaccination. They were provided with information relating to local carers’ support groups and offered routine screening for anxiety, depression and other health problems. We saw evidence that the practice had carried out anxiety or depression assessments on 86 carers and 217 carers had received a flu vaccination.

The areas where the provider should make improvements are:

• Review and develop the system for significant event reporting to ensure that learning is identified, shared with staff and documented.
• Continue to monitor and improve medication reviews to ensure records contain clear evidence to support that compliance, ongoing indication for continuing the medication, it’s effectiveness and safety (including side effects) are considered.
• Continue to monitor and improve the process for issuing acute medications and ensure there are adequate clinical notes to support this.
• Review and improve mechanisms within the practice to allow staff to voice any concerns.
• Take steps to assure themselves that all clinicians have completed safeguarding training to the appropriate level.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice