Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Canbury Medical Centre on 17 January 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Overall, risks to patients were assessed and well managed; however, one member of non-clinical staff who acted as a chaperone had not received a Disclosure and Barring Service (DBS) check (the practice had risk assessed this decision and internal guidelines stated that the chaperone should not be left alone with a patient).
• The practice had systems in place to ensure that blank prescription sheets and pads were securely stored; however, they did not have a process in place to monitor their use. The practice had a prescribing policy which included the process for disposing of uncollected prescriptions; this did not include clinical oversight of the prescriptions being destroyed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. The practice had two Advanced Nurse Practitioners who ran acute clinics; we saw evidence that opportunities were available to them to request advice from GPs, however, there was no formal process in place for the supervision of this enhanced role.
• 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; however, the complaint responses we viewed did not include contact information for the Parliamentary and Health Service Ombudsman. Improvements were made to the quality of care as a result of complaints and concerns.
• Some patients said it could be difficult to get through to the practice by phone; however, the practice was in the process of addressing this issue. We viewed the appointments system and found that pre-bookable appointments were available within a few days, and urgent appointments were available the same day, including after-school appointments reserved for children.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had processes in place to ensure that all permanent staff were up to date with the training they needed to carry-out their roles safely. We saw evidence that the practice checked that locum staff had received the required training prior to starting work at the practice; however, there was no process in place to check that long-term locum staff kept up to date with refresher training.

• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• They should ensure that all responses to complaints include contact information for the Parliamentary and Health Service Ombudsman.
• They should ensure that all staff who act as chaperones have received a DBS check.
• They should continue to work on implementing a log of prescription sheets and pads received and issued, and review their policy for disposing of uncollected prescriptions to ensure that it includes clinical oversight.
• They should consider reviewing the scope of the Advanced Nurse Practitioner role and the arrangements for their supervision and support to assure themselves that the system is safe.
• They should ensure that processes are in place to check that long-term locum staff are up to date with required refresher training.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice