Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Neots Health Centre (Malling Health) on 18 October 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 18 October 2016 inspection can be found by selecting the ‘all reports’ link for St Neots Health Centre (Malling Health) on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 18 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There were contractual restrictions placed on the practice in relation to the number of patients the walk in centre was funded to see by NHS England. In the event of full capacity, the practice had introduced effective systems and processes to ensure all patients were appropriately assessed before signposting to other services. We saw evidence that demonstrated the practice responded to any patients needing urgent treatment in a timely manner.Data had been collated and an audit completed; this audit identified the patient’s presenting symptoms and the actions taken by the practice to ensure these actions were appropriate.

• Arrangements for safeguarding reflected relevant legislation and local requirements. Policies were accessible to all staff. Safeguarding concerns were clearly recorded in patients’ electronic records.

• The practice had improved the infection prevention and control arrangements, a recent infection control audit had been undertaken with most identified actions completed.

• We saw that the immunisation status of staff was recorded and risk assessments were in place.

• Patient Group Directions had been adopted by the practice to allow nurses to administer medicines in line with legislation. A master sheet gave oversight ensuring they would be updated in a timely way.

• The practice had implemented processes which evidenced that they proactively supported and encouraged patients who may be at risk of bowel or breast cancer to attend for screening.

• Since our last inspection additional nurse practitioners had been employed. They told us they received good support from the practice and advice from GPs was easily accessible. The rotas were designed to ensure that at least one nurse practitioner was on duty when the healthcare assistant (HCA) was seeing patients. This ensured the HCA was fully supported to undertake the tasks delegated to them.

• The practice evidenced that they had made every effort to engage all locum staff in the management of the practice; we saw evidence of meetings and regular letters sent to all locum staff.

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 the St Neots Health Centre and Walk In 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 well managed but there was room for improvement.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received training needed to provide them with the skills, knowledge, and experience to deliver effective care and treatment. Improvement was needed in the clinical support and guidance for the health care assistant.
• Patients said they were treated with compassion, dignity and respect.
• Information about services and how to complain was available and easy to understand.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure safeguarding concerns are recorded appropriately within electronic clinical records.
• Whilst patient group directions were signed, there was scope to ensure that the paper audit trail was comprehensive for all registered nursing staff.
• Ensure infection control arrangements are effective and monitored on a regular basis.
• Ensure that immunisation status of staff is risk assessed.
• Proactively support and encourage patients who may be at risk of bowel or breast cancer to attend for screening.
• Ensure that sufficient clinical support is in place for nurses and health care assistants.
• Ensure that locum staff are involved and can influence improvement plans across the service.

The areas where the provider must make improvement are:

• Assess and mitigate the potential risks around turning patients away from the walk in centre (due to contractual restrictions).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice