Letter from the Chief Inspector of General Practice

We first inspected Ambar Medical Practice on 4 November 2015 as part of our new comprehensive inspection programme. The practice was rated as inadequate and was placed into special measures.

We carried out a comprehensive inspection of Ambar Medical Centre on 9 November 2016.

This inspection was conducted to see if improvements had been made following the inspection in November 2015 where we identified areas where the provider must make improvements. At the time of the inspection in November 15 Dr Ahmed was the registered provider. They are no longer registered with CQC having left from the practice in December 2015. Dr Lodhi is now the registered provider with the CQC to deliver the regulated activities. Overall the practice is rated as Requires Improvement.

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

• We noted that the new management team in place had introduced effective systems and processes to monitor safety of patients and staff.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Since the last inspection in November 2015, the practice had introduced a system to analyse significant events and incidents, these were documented and shared with staff.
• Effective recruitment procedures have been implemented since the comprehensive inspection in November 2015. This included Disclosure and Barring (DBS) checks for staff that required them.
• Patients’ records were being reviewed and updated accordingly, as errors in data and medication reviews were found at the previous inspection.
• Patients we spoke with on the day of the inspection were positive about the staff but commented on the difficulties in getting appointments. We saw that staff were friendly and helpful and treated patients with kindness and respect.
• The practice had introduced a programme of audits that were driving improvement in performance in order to improve patient outcomes.
• It was noted that the practice had made improvements and were making changes to the systems and processes to improve patient outcomes and the management of the practice.
• The management team introduced a series of formal meetings to ensure all staff and community services were kept up to date, this included team meetings on a monthly basis and clinical staff meetings every two weeks.
• The practice had introduced formal governance arrangements to manage and assess the risk and quality of the service it provided, including infection control procedures.
• We saw that following our comprehensive inspection in November 2015, effective systems had been implemented to ensure patients’ needs were assessed and care was planned and delivered following best practice guidance.
• An effective system had been put in place to monitor and act on Patient Safety Alerts, information from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS).
• The provider implemented the use of nationally recognised guidance, including guidelines issued by NICE (National Institute for Health and Care Excellence).
• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice had reviewed their current patient record system to ensure that content and coding was effective.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.
• There was a clear leadership structure and staff felt they were supported by the practice manager and GP. The practice had set up a patient participation group, which was in its infancy, but on speaking with the chair of the group, they were committed to supporting the practice in moving forward.

There are areas where the provider should make improvements:

• Continue to review clinical registers to ensure accuracy of data and improved outcomes for patients.
• Continue to encourage patients to attend screening and immunisations including cytology, child immunnisations and cancer screening.
• Continue to monitor patient satisfaction through feedback.
• Review access to online services to improve patient’s satisfaction and a practice website to guide patients on services available.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Ambar Medical Centre on 9 November 2016. The overall rating for the practice was requires improvement.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Ambar Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 15 February 2018.

This practice is rated as good overall. (The practice was rated requires improvement at our previous inspection on 9 November 2016).

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

Our key findings were as follows:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learnt from them and improved their processes. Information and learning from significant events was discussed at clinical and practice meetings.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The practice worked closely with other health and social care professionals involved in patient’s care. Regular meetings with the community nursing teams and palliative care teams were held to discuss the care of patients who were frail / vulnerable or who were receiving end of life care. The nurse practitioner met regularly with the health visitor and midwife to discuss new patients under the age of five, children with protection plans, looked after children and pregnant ladies where there were any concerns.
• The practice had carried out clinical audits to review the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. The audits seen demonstrated quality improvements.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• We found that the scores for GPs and nurses in the GP Patient Survey published July 2017 were lower than the local averages. The practice had developed an action plan to address these issues and was carrying out a patient satisfaction survey based on the same questions as the national survey. The results collated to date demonstrated an improvement in patient satisfaction.
• The practice was committed to health education and promotion for the whole of the practice population. Information was available in a range of different languages and the lead GP was involved with community groups to share information with the wider community.
• The practice co-hosted a quarterly support meeting with Walsall Carers Association for carers and cared for patients. Information for carers was on display in the waiting room and on the website.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

There were areas of practice where the provider should make improvements:

• Continue to monitor and improve on patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice