Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Consulting Rooms on 9 January 2017. 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 for reporting and recording significant events.

• The practice did not have an effective system to manage patient safety alerts.

• Staff did not have current training in how to recognise signs of abuse in vulnerable adults and children.

• The practice did not have a nominated infection control lead nor had any practice led audits taken place in the previous 12 months.

• The governance framework did not ensure the practice undertook regular and comprehensive reviews of the quality of service.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Clinical audits demonstrated quality improvement.

• 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.
• Patients could make an appointment in advance with a named GP.
• 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 must make improvement are:

• Review and consider processes concerning Medicines and Healthcare products Regulatory Agency (MHRA) alerts.

• Review and consider infection control within the practice.

• Review and consider audit processes of emergency medicines.

The areas where the provider should make improvement are:

• Identify clearly to patients the availability of extended hours.

• Ensure staff training records accurately reflect training staff had received.

• Continue to develop the patient participation group (PPG) to ensure engagement with patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we inspected The Consulting Rooms on 19 December 2013, we found that people were not fully protected against the risks associated with unsafe treatment or care. Staff were not adequately trained and supported to carry out their roles effectively. The majority of staff had not completed most of their basic (mandatory) training or received an annual appraisal. There was little job specific training available to nurses and non-clinical staff and no system was in place at the practice to monitor the completion of staff training. We judged this to have a minor impact on people using the service.

We inspected the service again, to check improvements had been made. During this inspection, we found that the risks to patient care and treatment were minimised as staff received appropriate training and professional development.

Our conversations with staff and review of training documentation and staff files demonstrated that all staff had received or were scheduled to receive an annual appraisal by August 2014. We saw there was a system in place to monitor the completion of training and most staff were up to date with their basic (mandatory) training. We found that nurses attended relevant study days and clinical skills courses and the reception staff had received comprehensive training on the new computerised patient management system installed at the practice.

We found the service to be welcoming with friendly staff. Information was displayed for people using the service, including health promotion, access to support services, information about the practice and other services available. There was a touch screen booking in facility in the reception area and appointments could be made on line using the practice website.

We spoke with eight people who all spoke highly of services provided to them. We also spoke with staff who said they enjoyed working in the practice and described some of the recent changes that had been made, which were viewed positively.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual needs. One person said, "The doctors are very nice. I’ve been seeing the same one for many years. Speaks for itself really."

We saw that there was a system to ensure repeat prescriptions were available promptly and medicines that were kept at the practice were stored safely.

Many of the staff had been employed for a number of years and were familiar with the practice. There was an electronic e-learning system in place to facilitate mandatory training, but this had not been fully implemented. Furthermore there was little evidence that staff underwent regular supervision or appraisal.

The practice had an electronic records system, which was used by all staff. Paper records received from other areas, when people changed practices were stored safely.