Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beccles Medical Centre on 6 October 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and responsive services. We found the practice was outstanding for providing well-led services. It was also good for providing services for older people, people with long-term conditions, families children and young people, working age people (including those recently retired) people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

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.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. There was a strong learning culture within the practice. 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.
• Patients overall were happy with the appointment system because they were able to get telephone advice or be seen that day. However, some patients, particularly those of working age found the call back system was not always convenient for them to manage. The practice did offer flexibility to help meet patients' needs wherever possible for example, by arranging call backs at more convenient times with a named GP. Continuity of care was promoted by providing patients with urgent appointments that same day. This was usually with the GP who had dealt with the initial call.
• 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.

We saw areas of outstanding practice including:

• The practice had a clear vision that was shared and owned by staff. They followed structured policies and processes to deliver high standards of care. Performance and governance arrangements were proactively reviewed. Leadership responsibilities were appropriately delegated and staff were able to demonstrate this worked well in practice. The clinical team shared decision making (clinical and non-clinical) and worked effectively through clear communication and mutual support. There was a strong culture of shared learning and improvement to ensure that patients' needs were met.

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

Importantly the provider should

• review the Chaperone policy with staff to ensure they all understand their role as a chaperone.
• ensure that any recommendations made following the legionella management and risk assessment in January 2014, are actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beccles Medical Centre on 9 January 2019 as part of our inspection programme. The practice was previously inspected in March 2016 and rated as good overall and outstanding for providing well led services.

Our inspection team was led by a CQC inspector and included a GP specialist advisor and a practice manager specialist advisor.

Our judgement of the quality of care at this service is based 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.

This means that:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• The practice was fully engaged with reviewing and monitoring the clinical service they offered and used this information to make changes and drive care. For example, the practice regularly reviewed data from the Clinical Commissioning Group and used this to drive improvement within the practice.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered. For example, the practice had engaged with the Social Prescribing and MIND charities to enable patients to be seen in a familiar environment.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
• The practice encouraged continuous improvement and innovation. For example, the practice had a diverse skill mix within the practice and encouraged staff to undertake further education.
• Staff reported they were happy to work in the practice and proud of the changes that had been made.

We saw an area of outstanding practice:

• The practice had a Care Services Integration Project team (CSIP); the team saw patients who had been discharged from hospital, vulnerable patients and housebound patients. The team consisted of a community matron, respiratory nurse specialist, emergency care practitioner and a GP. If the team wished to discharge a patient, the GP would review and authorise where appropriate. The team managed patients with complex needs and reviewed all patients over 75 who had been admitted to hospital or had attended Accident and Emergency. The aim of the team was to reduce unplanned admissions to hospital. In the past 12 months, the team had prevented 256 GP home visits and 59 admissions to hospital.

We rated the practice as requires improvement for providing safe services because:

• Not all staff had received training in areas including safeguarding, infection prevention and control, fire safety and chaperoning. Although the practice reported the immunisation of staff was checked on employment, there was not documented evidence for all clinical staff. The health and safety risk assessments completed were not comprehensive and did not address all risks within the practice. The practice did not share the learning of all significant events.

We found the provider must:

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

We found the provider should:

• Continue to review and improve outcomes relating to access in the GP Patient Survey.
• Share the learning from all significant events to ensure staff are informed of changes.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice