Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection October 2015 – Requires improvement and two shoulds regarding:

• Ensure that all staff that do not have a disclosure and barring service (DBS) check in place are appropriately risk assessed, in order to ensure patient safety.
• Review processes for checking that prescription pads and confidential patient records are stored securely in line with the practices policies on safe prescription storage and confidentiality).

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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at The Gateway Medical Practice on 15 March 2018 as part of our scheduled inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use; however, not all patients reported that they were able to access care when they needed it. The practice had taken action to address low data scores in the patient GP survey and staff and patients reported that this had a positive impact.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are;

• Continue to develop and embed the actions taken to improve patient access to appointments.

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 Gateway Medical Practice on the 20 October 2015. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, interviewed staff of all levels and checked that the right systems and processes were in place.

Overall the practice is rated as requires improvement. Specifically, we found the practice to require improvement for providing caring and responsive services. It was good for providing safe,effective and well-led services.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patient’s needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• Staff had received training appropriate to their roles and any further training needs had been identified and training planned.
• The practice had responded to low scores in the National Patient survey, in order to improve services.
• The practice had a clear vision which had quality and safety as its top priority. A business plan was available, which was monitored and regularly reviewed and discussed with all staff.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure that all staff that do not have a disclosure and barring service (DBS) check in place are appropriately risk assessed, in order to ensure patient safety.
• Review processes for checking that prescription pads and confidential patient records are stored securely in line with the practices policies on safe prescription storage and confidentiality.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 14 October 2014 we carried out an announced inspection to The Gateway Medical Practice.

The Gateway Medical Practice is located in the Northfleet area of Gravesend in Kent. Approximately 7200 are registered with the practice. We carried out a comprehensive inspection of the practice on 14 October 2014.

The practice was going through a period of transition and had a new practice manager who had been in post for three months. . A nurse practitioner had been introduced to provide an extra seven and a half hours of appointments for patients. The change had been made as a response to feedback from a patient survey carried out in March 2014. Patients who had responded to the satisfaction survey had expressed that they could not get appointments when they needed them or get through on the telephone. Patients we spoke with told us that although the extra appointments had been added with the nurse practitioner they were still experiencing problems getting to see a GP.

We spoke with twenty two patients during the inspection. We met with two members of the patient participation group and spoke with two GPs and a range of practice staff.

Gateway Medical Practice was rated requires improvement overall

Our key findings were as follows:

• Patients were happy with the care treatment and support they had received. Patients told us they had been involved and felt included in decisions about their care, treatment and support at the practice.

• Patients had concerns with the current appointment system and found it difficult to obtain an appointment when they needed one and they were often unable to get through on the telephone.

• The practice had not engaged patients and staff sufficiently in the operation of the service or ensured that staff had received appropriate learning and development opportunities to enable them to provide effective care, treatment and support to patients.

• The practice was clean and patients told us that they had no concerns with the cleanliness of the practice 

However, there were also areas of practice where the provider needs to make improvements. 

Importantly, the provider must:

• ensure that all staff receive regular training and complete appropriate induction to prepare them for their role
• Implement robust, formal systems to monitor the quality of care, treatment and support patients receive.
• Have a clear clinical audit programme for ensuring the safety of patients, staff and visitors that includes a review of infection control and act on the results to improve the service.

  • Seek and act on the views of patients and staff to improve the service.

In addition the provider should:

• Review the reception and waiting area to improve the risk of confidential issues being overheard.  
• Implement contingency planning to avoid disruption to patients should the service be unavailable

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice