This practice is rated as Requires improvement overall. (Previous inspection 14 September 2017 – Good overall, but Requires improvement for Safety. The same rating was awarded following the inspection on 26 October 2016.)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at Brigstock Medical Centre on 12 April 2018. This was because there had been previous breaches of regulations.

At this inspection we found:

• A number of systems and processes were not operating effectively to keep patients, staff and people visiting the practice staff. Fire safety was not properly assessed or managed, recruitment checks were incomplete and there were other checks of medicines that were not being performed consistently.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines. Group consultations for some long term conditions had been introduced and were reported to be effective and popular with patients.
• Staff 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.
• There was some evidence of learning and improvement. However, some of the issues (e.g. safeguarding training) related to concerns that we raised with the practice previously and were told had been addressed.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Please see the requirement notice section at the end of the report for more detail.

The areas where the provider should make improvements are:

• Consider how to improve uptake of cervical screening and bowel cancer screening.

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 at Brigstock Medical Centre on 26 October 2016. The overall rating for the practice was good, with a rating of requires improvement for the Safe key question. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Brigstock Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 14 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 26 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good, but rated as requires improvement for keeping people safe.

Our key findings were as follows:

• At the last inspection we found that some staff had not completed the recommended training in keeping patients safe from abuse. At this inspection, we found that a number of staff members had still not completed the recommended training in keeping patients safe from abuse.
• There was now a defibrillator.
• The chaperone service was advertised to patients and details of the arrangements were included in the non-clinical staff induction.
• The practice had maintained the infection prevention and control arrangements in place at the last inspection, but had not made any improvements to the overall leadership or governance. There was no system to update staff training in infection control, after induction.

In response to our recommendations, the practice had:

• Improved the information available for carers, with notices to advertise support available and added a leaflet to registration packs.
• Acted on patient satisfaction with the telephone and appointment systems by introducing patient online access, and increasing the reception staff. In a practice survey in December 2016, and 88% of the patients were happy with the ability to get through over the phone and 85% of the patients were happy with the appointment system.

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

Importantly, the provider must:

• Ensure patients are protected from abuse and improper treatment.

In addition the provider should:

Review infection prevention and control leadership and audit arrangements, to ensure that all risks are being identified and acted upon. 

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 at Brigstock and South Norwood Partnership on 26 October 2016. Overall the practice is rated as requires improvement.

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

• The practice had systems in place to keep patients safe and safeguarded from abuse, but these were not sufficiently well embedded. Some clinical staff had not received training in safeguarding adults, or recent training in child safeguarding. The non-clinical staff had not undertaken safeguarding training and some of them we spoke to were not very confident in their understanding of behaviour that might indicate a safeguarding issue, although they were aware of their responsibilities if they were concerned about a patient. Non-clinical staff were not trained to act as chaperones, and did not do so, but some of those we spoke to said they thought they might be a chaperone if a nurse or healthcare assistant were not available.
• There were areas of risk that had not been effectively assessed and addressed, such as electrical testing and arrangements for medical emergencies. Not all clinical staff had had recent basic life support training. There was no defibrillator, and the practice had not carried out a risk assessment to support the decision not to acquire one.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was generally well equipped to treat patients and meet their needs, although there was no defibrillator.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure there are adequate arrangements to manage medical emergencies; either obtain a defibrillator or complete a risk assessment which mitigates the risks of not having one.
• Ensure that staff receive the training required for their role at the expected frequency (including safeguarding, information governance and role-specific training); ensuring that training within the practice covers the required topics at the appropriate level for the role, and that all clinical staff complete annual basic life support training for clinical staff. Arrange annual basic life support training for non-clinical staff (in line with current guidance).
• Advertise the chaperone service and ensure that staff are clear who can and cannot act as a chaperone.
• Ensure all staff have up to date training in safeguarding adults and children, and are confident in their understanding of behaviour that might indicate a safeguarding issue.

The areas where the provider should make improvement are:

• Risk assess portable electrical appliance testing arrangements.
• Review infection prevention and control leadership and audit arrangements, to ensure that all risks are being identified and acted upon.
• Continue to monitor (and where appropriate act upon) patient satisfaction with the telephone and appointment systems.
• Consider providing written information for carers about local support services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice