Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Peter’s Medical Centre on 17 August 2016. The overall rating for the practice was good. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for St Peter’s Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 October 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 17 August 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:

At the inspection on 17 August 2016, the practice was rated overall as ‘good’. However, within the key question safe, areas were identified as ‘requires improvement’, as the practice was not meeting the legislation around ensuring adequate arrangements were in place to ensure care and treatment to patients was provided in a safe way in relation to the provision of medical equipment. The practice was issued a requirement notice under Regulation 12, Safe care and treatment.

Other areas identified where the practice was advised they should make improvements within the key question of safe included:

• Complete and record a risk assessment of the practice’s decision not to stock medicine excluded from the emergency medicines kit.

• Review staff records to confirm pre-employment reference checks are documented for all staff.

• Secure with the landlord of the premises, the implementation of action arising from the latest fire risk assessment.

At our October 2017 inspection we reviewed the practice’s action plan submitted in response to our previous inspection and a range of supporting documents which demonstrated they are now meeting the requirements of Regulation 12, Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice also demonstrated improvement in the other areas identified in the report from August 2016 which did not affect ratings. These improvements have been documented in the safe section, showing how the registered person has demonstrated continuous improvement since the full inspection.

Areas identified at the August 2016 inspection where the practice was advised they should make improvements within another key question of caring included:

• Consider making information on display at the practice more visible to patients.

• Review the arrangements for the storage of patient records to mitigate potential security risks.

At our October 2017 inspection we found significant improvements in the display and content of information to patients. Patient information leaflets, the practice leaflet and patient booklet had been updated and were available within the patient waiting room; the layout of the patient information board had been improved; the patient information screen had been updated and the practice manager trained in its use; and the practice website had been updated and its content managed at practice level to ensure information is kept accurate and current. We saw the minutes from the July 2017 PPG meeting, where members commented positively regarding changes.

The practice had also improved the security of patient records previously kept in unlocked cabinets and boxes. All such records, including confidential waste, were now stored in lockable cabinets or boxes and secure key management arrangements were in place.

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 St Peter’s Medical Centre on 17 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.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented sufficiently in all respects to ensure patients were kept safe. There were some deficiencies, in particular with regard to ensuring the safety of medical equipment.
• 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.
• 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.
• The majority of 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.
• 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.

We saw one area of outstanding practice:

The practice initiated several activities to engage with the local community and promote health and well-being. These included an annual health fayre organised with the PPG, hosting stands for a wide variety of health agencies. At this event visitors were able to attend presentations/workshops such as stop smoking, relaxation, and Fit for Life; receive influenza vaccinations and health checks; and it enabled important networking for the local community.

The areas where the provider must make improvements are:

• Review the system in place for the use and storage of liquid nitrogen to ensure that the practice is fully compliant with national guidance, including a risk assessment for Control of Substances Hazardous to Health (COSHH).

In addition, the areas where the provider should make improvements are:

• Complete and record a risk assessment of the practice’s decision not to stock medicine excluded from the emergency medicines kit.
• Review staff records to confirm pre-employment reference checks are documented for all staff.
• Secure with the landlord of the premises, the implementation of action arising from the latest fire risk assessment.
• Consider making information on display at the practice more visible to patients.
• Review the arrangements for the storage of patient records to mitigate potential security risks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice