Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Torkard Hill Medical Centre on 2 December 2015. A breach of legal requirements was found in that administrative staff who may undertake chaperone duties had not received a disclosure and barring service (DBS) check, and a risk assessment had not been completed 

to determine whether a DBS 

check was required.

Overall the practice was rated as good. In view of the above the practice was rated as requires improvement for providing safe services.

After the comprehensive inspection, the practice wrote to us to say what action they had taken to meet the legal requirement in relation to the breach.

We undertook this desk based review on 30 August 2016 to check that the provider had completed the required actions, and now met the legal requirements. We did not visit the practice as part of this inspection. This report only covers our findings in relation to the above requirement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for

Torkard Hill Medical Centre 

on our website at www.cqc.org.uk.

Our finding across the area we inspected was as follows:The practice had taken appropriate action to meet the legal requirement.

• The practice is rated as good for providing safe services.​

• The recruitment and chaperone policies had been reviewed to ensure the practice obtained appropriate Disclosure and Barring Service (DBS) checks for all staff.

• Records showed that a DBS check was obtained for all appropriate staff immediately after the comprehensive inspection.

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 Torkard Hill Medical Centre on 2 December 2015. 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.
• Most risks to patients were assessed and well managed such as health and safety, safeguarding and infection control. However, risks had not been assessed in relation to non clinical staff undertaking chaperone duties. These staff had not been risk assessed or received disclosure barring service checks. This was however, rectified immediately following our inspection for all non clinical staff providing chaperone duties.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. A programme of continuous clinical audit was in place which drove quality improvement. Staff had 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. The practice was rated highly by patients in patient survey data and feedback we obtained from patients supported this.
• Information about services and how to complain was available and easy to understand. The practice ensured a robust approach was adopted to address all complaints received.
• Patients said however that they found it difficult to make an appointment with a named GP and get through to the surgery by phone to make an appointment. The practice had reviewed patient accessibility and had invested additional resource into GP led telephone triage. The practice was planning to expand its building to accommodate an increasing patient list.
• The practice had good facilities, including a reception waiting area which had been recently redesigned for patient comfort and convenience and it 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.

We saw one area of outstanding practice:

The practice had proactively sought to screen all of its care homes patients considered as suitable for dementia screening. This identified 55 to date who were suitable and 62% of these were found to have a diagnosis of dementia. Those identified had their prescription reviewed to ensure optimisation and compatibility with the patients’ condition, care plans developed and referral where required to the dementia outreach team. The practice had also sought to identify any carers of these patients, even if they were not patients at the practice to offer them support. Whilst it was noted that work was ongoing, all identified carers have been offered an annual health check, membership of a carers group and asked to join the patient participation group. (PPG) Those identified as carers were also asked to engage in a collaborative dementia research project which the practice hoped will further increase their understanding of best practice for supporting patients and carers living with dementia.

There are areas where the provider must improve;

The provider must ensure the arrangements in place for identifying, assessing and mitigating risk are effective in relation to non clinical staff undertaking chaperone duties. This includes assessment of whether disclosure barring service checks are required. It has however been noted that the provider took immediate action to address the risk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice