We carried out an announced comprehensive inspection at Blackfriars Medical Practice on 11 January 2019 as part of our inspection programme.

At the last comprehensive inspection in April 2018 we rated the practice as good for the key questions responsive and caring; and requires improvement for safe, effective and well led. The overall rating was requires improvement. This was because:

• The practice had not established effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 now 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.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• 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 well-led and managed the delivery of high-quality, person-centre care.

The areas where the provider should make improvements are:

• Temperature testing of the water outlets should be done in line with the risk assessment.
• The practice should consider the need to hardwire the fridge to the mains electrical circuit.

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

On 20 April 2018 we carried out a full comprehensive inspection of Blackfriars Medical Practice. This resulted in a warning notice being issued against the provider on 15 May 2018. The Notice advised the provider that the practice was failing to meet the required standards relating to Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities). A copy of this report can be found on our website:

On 5 July 2018 we undertook a focused inspection to check that the practice had met the requirements of the Warning Notices. At this inspection we found that some improvements had been made and the provider had complied with some parts identified in the warning notice. In particular, we found that:

• The practice had made improvements in relation to training. We found that a system was now in place to check the training of staff members. However, we found that evidence of safeguarding training for a locum member of staff was not available at the time of the inspection, but was provided to us after the inspection.
• Recruitment procedures had been improved and the practice now ensured that professional medical registration was correct, and medical indemnity was in place for all staff members including locums. However, we found that identification checks had not been performed on all locum staff members.
• Clinical supervision was in place for all staff members and the practice kept a record of any discussion that took place. The lead GP had also implemented a system of randomly checking consultations to ensure current guidelines were followed.
• The significant event policy had been updated to ensure all incidents were recorded within 24 hours of discovery.

The rating awarded to the practice following our full comprehensive inspection 20 April 2018 of requires improvement remains unchanged. Improvements remain ongoing and the practice will be re-inspected in relation to their rating in the future.

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 of Blackfriars Medical Centre on 17 September 2015. Overall the practice is rated as good.

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. 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.

• Patients told us that they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

However there were areas of practice where the provider should make improvements:

The practice recruitment policy referred to obtaining verbal references for new staff. The provider should keep a record that reflects these checks have been made and the outcome of those checks.

Whilst arrangements were in place to summarise the medical records of new patients to the practice it was evident that there was a back log in summarising the medical records of new patients to the practice (from January 2015). There was no evidence to indicate this has to date impacted on patient welfare. However to minimise risk and maximise patient safety the provider should take action to clear this back log and ensure information in patient records can be easily and quickly accessed by the clinicians.

We noted that in the absence of a health care assistant new patients were not currently completing a health questionnaire on registration. Whilst we acknowledge that the patient demographic of the practice means that the vast majority of new patients present ‘acutely’ and seek an appointment with a clinician (when initially history taking/screening takes place) this may not always be the case. Therefore the completion of a health questionnaire by new patients should be requested and assessed by a clinician to assess any immediate health risks.

We saw that clinical and practice meetings were held regularly. We note that meetings were held on the same day of the week. This meant that whilst all staff could add items for discussion (and received minutes of the meeting) not all staff could attend. Consideration should be given to reviewing dates of future meetings to enable staff who may not work particular days to attend some meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection October 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at Blackfriars Medical Practice as part of our inspection programme.

At this inspection we found:

• There were clear responsibilities to support governance but some systems and processes were lacking.
• Recruitment procedures were in place but these were not always followed. Not all staff had received training appropriate to their role.
• Significant events were not always reported in a timely manner.
• The practice acted on and learned from external safety events as well as patient and medicine safety alerts.
• The practice 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 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.

The areas where the provider must make improvements are:

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice