We carried out an announced comprehensive inspection at Adam House Medical Centre on 7 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The service 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 people with compassion, kindness and respect, and involved them in decisions about their care. Patient interviews and feedback received through CQC comment cards supported our observations.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of good quality, person-centre care.
• At our previous inspection in 2014, two areas were identified in which the provider should consider making further improvements; these related to the completion of audit cycles and formal clinical supervision for nurses. The practice had considered these points and was able to demonstrate the improvements they had made when we inspected in January 2019.

We saw the following area of outstanding practice:

• The practice employed a hospital-based diabetes nurse specialist for two sessions each week. The nurse focused on achieving good outcomes for patients with complex needs and engaging them with their treatment regimes. The impact was seen by low exception reporting rates for patients with diabetes, which were more than half below the local and national exception reporting percentages.

In addition, the provider should:

• Review the availability of risk assessments to explain the absence of some recommended emergency medicines on site.
• Ensure that vaccine storage is maintained in line with guidance at all times.
• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Improve the uptake of annual health reviews for patients with a learning disability.
• Review the practice complaints policy and procedure to ensure these were in line with recognised guidance

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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

Letter from the Chief Inspector of General Practice

We inspected this practice on 28 January 2015 as part of our new comprehensive inspection programme. This is the first time we have inspected this practice.

The overall rating for this practice is good. We found the practice to be good in the safe, effective, caring responsive and well led domains. We found the practice provided good care to people with long term conditions, families, children and young people and people in vulnerable circumstances, older people, working age people and people experiencing poor mental health.

Our key findings were as follows:

• Patients told us they were satisfied with the appointments system and told they could see a GP when they needed to.
• Patients were kept safe from the risk and spread of infection as the provider had carried out audits and acted on their findings
• Patients were treated with dignity and respect and spoken to in a friendly manner by all staff
• Systems were in place to keep patients safe by assessing risk and taking steps to reduce this. We saw evidence of learning from previous incidents.
• Patients, their relatives and carers were involved in all aspects of treatment and their opinions were listened to and acted upon.
• 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.
• The practice had a very active and involved Patient Participation Group (PPG) carried out all patient surveys which included patient experience of individual clinicians

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

The provider should:

• Ensure that all audits cycles are completed by ensuring a second cycle is carried out to demonstrate whether improvements had been made following re-audit.
• Clinical supervision should be provided for all clinical staff including nurses to enable and support their continuous professional development.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice