We carried out an announced comprehensive inspection at Bruce Grove Primary Healthcare Centre on 24 July 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Bruce Grove Primary Healthcare Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 March 2018 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 24 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• A practice survey had been undertaken in November 2017 to gauge the views of patients which showed positive results. The practice carried out a follow up survey in March 2018 and are awaiting the results of this.

• Poor QOF scores had been reviewed and systems put in place to achieve improvement. This included clinical audit and a new system for recalling patients for review.

• The practice had reinstated the Patient Participation Group (PPG) and was working with the group to improve service to patients.

In addition the provider should:

• Continue to look at ways to improve QOF scores and patient outcomes especially in relation to patients with diabetes.

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 Bruce Grove Primary Healthcare Centre on 5 December 2016. The practice was rated requires improvement for providing safe, effective, caring and well led services. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Bruce Grove Primary Healthcare Centre on our website at www.cqc.org.uk.

This inspection was undertaken to follow up on outstanding breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and was an announced comprehensive inspection on 24 July 2017. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• The practice did not have an active patient participation group (PPG). However the practice was working towards establishing this through a number of practice open days to attract patients to talk about the practice.
• Low scores received from the national patient survey were being addressed by the practice. However this was having little impact.
• the practice had low scores for QOF. an action plan had been developed to improve these scores but it was having little impact on patient outcomes.
• An infection control audit had been undertaken and an action plan had been developed to address the issues identified.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Data showed patient outcomes were low compared to the national average. The practice had produced an action plan to address this and to improve scores and patient outcomes.
• We saw evidence that audits were driving improvements to patient outcomes.
• Information about services was available in a way patients could access.
• The practice had a number of policies and procedures to govern activities.
• Patients said they were treated with compassion, dignity and respect.

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

The provider must:

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

The provider should:

• Continue to look at ways to improve QOF scores and patient outcomes especially in relation to patients with diabetes.

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 Bruce Grove Medial Centre on 5 December 2016. Overall the practice is rated as requires improvement.

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

• An infection control audit had been undertaken but an action plan had not been developed to address the issues identified. There was no schedule for the cleaning of hand held clinical equipment such as spirometer, nebuliser and ear irrigator.
• Child size pads were not available for the defibrillator and staff had not been trained in its use.
• The practice did not have an active patient participation group (PPG).
• Low scores received from the national patient survey had not been addressed by the practice.
• Care plans were not produced for patients that were discharged from hospital.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The practice had a number of policies and procedures to govern activity, however not all staff were aware of their existence, for example infection control and adult safeguarding policies.
• Data showed patients outcomes were low compared to the national average. Although some audits has been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect.
• Information about services was available in a way patients could access.

The areas where the provider must make improvements are:

• Produce an action plan to address the concerns identified in the infection control audit.
• Ensure child size pads are made available for the defibrillator and that staff are trained in its use.
• Undertake clinical audits and re-audits to improve patient outcomes.
• Ensure all staff are aware of policies used to govern the practice.
• Produce a schedule for the cleaning of hand held clinical equipment.
• Produce a plan of how the practice intended to improve QOF figures.

In addition the provider should:

• Review how the practice takes account of patient feedback including the implementation of a PPG.
• Review and address the low scores from the national patient survey.
• Implement care plans for patients that are discharged from hospital.

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 Bruce Grove Primary Healthcare Centre on 17 November 2014. Overall the practice is rated as good.

Specifically, we found the practice as good for providing effective, caring, responsive and well-led services. It required improvement for providing a safe service. It also required improvement for providing services for the care of older people, those with long term conditions, working age people (including those recently retired and students), families, children and young people and those whose circumstances make them vulnerable. The practice was rated as good for providing services to 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 report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Data showed patient outcomes were average for the locality. Some audits had been carried out, and there was some evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• Information about services and how to make a complaint was available and easy to understand.
• Urgent appointments were usually available on the day they were requested. However patients said they sometimes had to wait a long time for non-urgent appointments.
• The practice had a number of policies and procedures to govern activity. These were over five years old and had not been reviewed.
• The practice had not proactively sought feedback from patients.

The areas where the provider must make improvements are:

• Ensure all staff acting as chaperones have a Disclosure and Barring Service (DBS) check.
• Ensure that all necessary emergency medicines as per current guidance are available.
• Ensure portable appliance testing (PAT) is undertaken immediately and periodically;

In addition the provider should:

• Ensure an infection control audit is undertaken to monitor cleaning standards;
• Ensure Legionella testing or a risk assessment is undertaken;
• Ensure availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have one on-site.
• Ensure multidisciplinary meetings are carried out on a more formal basis and a written record is taken;
• Develop care plans for patients on the older persons register;
• Improve service availability for the working age population;
• Provide a system of patient feedback including the formation of a patient participation group (PPG);
• Update all policies and procedures as necessary.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice