Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 28 Beaumont Street on 5 April 2016. Overall the practice is rated as good, however improvements were required in providing effective services.

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.
• Risks to patients were assessed and well managed. However, there was not a comprehensive fire risk assessment available.
• Medicines were managed safely.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff mostly had the skills, knowledge and experience to deliver effective care and treatment.
• Some training and awareness was not monitored fully by the practice to ensure all training needs were undertaken by staff.
• National data suggested patients received their care in line with national guidance.
• 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 said it was possible to make an appointment with a GP or nurse and were very positive in comment cards about the appointment system.
• 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.
• Governance arrangements were in place for non-clinical aspects of the service.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas the provider must make improvements are:

• Ensure staff are aware of the principles and requirements of the Mental Capacity Act 2005 and the Gillick Competency.

• Improve the monitoring of training and the record keeping related to this monitoring.

The areas where the provider should make improvements are:

• Undertake a comprehensive fire risk assessment.

• Review the recording and coding of patient care on the patient record system to ensure that information is available to all staff in the delivery of care. This should include appropriate alerts on the system for vulnerable patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to Dr Sichel and partners we met with the practice manager and one of the GP partners. We spoke with five patients, two members of staff and with a representative of the patient participation group PPG.

Patients understood the care and treatment choices available to them. A patient told us "I was given the choice of where to go for my referral". We observed reception staff offering a choice of dates and times for appointments.

Patients were happy with the care and treatment they received. One patient said that their care was "brilliant. I am very happy." We saw that when patients required hospital care and treatment they were referred promptly.

The practice was clean and tidy and appropriate cleaning processes were in place. The risks of infection from waterborne bacteria had not been fully minimised because it had not been risk assessed.

Appropriate checks and selection processes took place before staff started work.

The practice had quality assurance systems in place. For example, prescribing of medicines was subject to audit.

Letter from the Chief Inspector of General Practice

In April 2016 we carried out a comprehensive inspection of 28 Beaumont Street. Shortfalls were identified relating to the effective delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make improvements to ensure that staff were aware of the principles and requirements of the Mental Capacity Act (2005) and the Gillick competencies.

We also found that the practice did not have an effective system for the recording and coding of patient care on the patient record system. The record system did not alert staff to vulnerable patients. This meant that information was not always readily available to all staff and delivery of care could be compromised. The practice had not undertaken a comprehensive fire risk assessment, and improvements were needed to monitor and record staff training provision.

The practice was rated as requiring improvement for effective services, and good for safe, caring, responsive and well led services. The practice had an overall rating of good.

We carried out a desk based inspection in November 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of training certificates for three members of staff, details of their fire risk assessment, and an updated staff training record document. In addition the practice also supplied a comprehensive assessment of the steps they had taken, to demonstrate that changes had been made.

We found the practice had made improvements since our last inspection in April 2016.

At this inspection we found that:

• The practice had provided training for members of the nursing and senior management team. This was to ensure that staff were able to understand and determine the principles of the Mental Capacity Act 2005, and Gillick competency.

• The practice had reviewed the recording and coding of patient care on the patient record system. As a result the practice had advised us that they were now auditing and monitoring this issue.

• The practice had instructed an independent company to assess the risk of fire in the practice and produce a comprehensive fire risk assessment.

• Actions from this risk assessment included regular fire drills and monthly audits of fire safety risks.

• Systems were now in place to reduce and minimise the risk of fire to both staff and patients.

• The practice had supplied a copy of their training records, to demonstrate the steps taken to improve the previous training recording issues found.

• Systems were now in place to monitor training and ensure that effective care is made available to patients.

Following this desk based inspection we rated the practice as good for providing effective services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 5 April 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice