This practice remains rated as Good overall. (First rated in November 2017)

The key question at this inspection is rated as:

Are services well-led? - Good

We carried out a focused inspection at The Symons Medical Centre on 17 July 2018. This inspection was undertaken to follow up a breach of regulation identified at the comprehensive inspection carried out in November 2017. At that time we identified that some management processes were not operated consistently. Specifically we found the practice did not:

• Operate a process for dealing with safety alerts that clearly identified who should action relevant alerts and confirm that action had been completed.
• Have a system in place to effectively offer physical health checks for patients diagnosed with a learning disability.
• Effectively promote the benefits of registering as a carer to enable appropriate support to be offered or given.
• Ensure that nursing staff were always given appropriate authorisation to administer vaccines.
• Maintain operational and clinical policies that were up to date and relevant to the day to day work of the practice.

Whilst the practice was rated good overall we rated provision of well led services as requires improvement.

At this inspection we found the practice had made significant improvements including:

• The practice had reviewed all operational policies to ensure they were relevant to the current provision of services.
• Implementing a revised system to call patients with a learning disability for a review of their physical health and had carried out 21 out of 46 such reviews in three months since April 2018.
• Ensured nurses had appropriate authorisation to administer vaccines.
• Promoting the benefits of registering as a carer resulting in a 46% increase in registered carers.
• Updated the process for dealing with safety alerts that were relevant to the practice to provide reassurance that these were seen and acted upon.

The area where the provider should make improvement is:

• Continue to monitor the effectiveness of promoting the benefits of registering as a carer.

Consequently the practice is now rated good for provision of well led services and remains rated good overall.

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

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as Good. (Previous inspection March 2015 – Good)

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? - Requires improvement

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 Symons Medical Centre on 8 November 2017. This inspection was carried out as part of our new phase of inspections, which commenced on 1 November 2017. The practice had previously been inspected in March 2015 and was rated as good overall.

At this inspection we found:

• The practice had 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Systems to identify, assess and manage risk were not always operated consistently. For example,the practice did not demonstrate awareness of The Electricity at Work Regulations that require a risk assessment of the electrical systems to determine their safety, the system to act upon safety alerts did not confirm actions had been completed, operational policies were not updated in line with the practice schedule and appropriate authorisation for nurses to administer immunisations was not completed in all cases.
• The practice GPs and nurses worked with other health professionals but records were not always kept of the meetings. Staff who were unable to attend the meetings would not be aware of decisions reached in regard to shared care and treatment.
• The practice had a system in place to identify carers and held a carers register. However, the number of carers registered was below 1% which did not reflect the number of carers identified in the last national census for the locality. The practice identified that the higher than average population of patients living in care homes might have affected the number of carers on their register
• The system for offering health reviews for patients with a learning disability was not operated effectively.

We saw two areas of outstanding practice:

• The practice recognised they had deaf patients registered and one of the GPs was learning British Sign Language to enable them to communicate with this group of patients.
• A joint audit project with local care homes on the benefits of appropriate hydration levels in elderly patients had resulted in fewer incidents of urinary tract infections.

The areas where the provider must make improvement as they are in breach of regulations is:

• Establish effective and consistently operated systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

• To implement a system that enables identification of patients with caring responsibilities to facilitate provision of appropriate support to this vulnerable group.
• Confirm, the recently introduced, recall system to provide patients with a learning disability with an annual health check functions effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of the Symons Medical Centre on 11 March 2015. We have rated the practice overall as Good. The practice was rated good in all five domains.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• 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.
• Risks to patients were assessed and well managed.

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

Importantly the provider should:

• Ensure all appropriate staff have chaperone training.

Ensure appropriate systems are in place to document clinical meeting discussions. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice