Letter from the Chief Inspector of General Practice

At the previous inspection on 20 July 2017, the practice had been rated as requires improvement for being Safe and Well-led. We identified breaches of regulations and served requirement notices under regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an announced focused inspection at Charlton House Medical Centre on 9 January 2018. The purpose of this inspection was to follow up on breaches of regulations identified at our previous inspection, and to review the actions taken by the practice. We saw that appropriate and sufficient action had been taken to comply with the requirements of the regulations.

The practice is now rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. As we have now rated the practice as good for providing safe and well-led services, this has revised the rating for the six population groups, as follows:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

• The practice had carried out: a fire risk assessment; infection prevention and control audit; and legionella risk assessment, and acted upon any recommendations.

• It had re-stocked its emergency-use medicines cabinet, and instituted regular checking to ensure that all emergency medicines remained in stock and in date.

• Staff treated patients with compassion, kindness, dignity and respect and involved them in decisions regarding their care and treatment.

• The practice had ensured that all staff had completed all necessary training.

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 Charlton House Medical Centre on 12 January 2015. The overall rating for the practice was good with a rating of requires improvement for the effective domain. The full comprehensive report on the January 2015 inspection can be found by selecting the ‘all reports’ link for Charlton House Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow-up inspection carried out on 20 July 2017. Overall the practice is now rated as requires improvement.

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

• Staff were provided with access to training and were formally appraised, however not all staff had completed training relevant to their role and one member of clinical staff had not been appraised since 2015.
• Arrangements for identifying, recording and managing risks, issues and implementing mitigating actions could be improved. For example, those related to fire safety and infection and prevention control measures for the premises.
• For the most recent published data from 2015/16 exception reporting was higher than the local and national averages for several clinical indicators. Exception reporting is the removal of patients from Quality and Outcomes Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.
• Procedures for managing the stock of emergency medicines were not clear.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• 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 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.

In addition the provider should:

• Consider ways to ensure that all staff are given a formal appraisal annually.
• Consider ways to ensure that all staff remain up to date with training relevant to their role.
• Consider ways to increase the number of carers identified identify ensure they can access a range of support in line with national guidance.
• Consider ways to reduce clinical exceptions for all long term conditions and ensure they meet the clinical criteria for exception reporting.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

At the previous inspection on 20 July 2017, the practice had been rated as requires improvement for being Safe and Well-led. We identified breaches of regulations and served requirement notices under regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an announced focused inspection at Charlton House Medical Centre on 9 January 2018. The purpose of this inspection was to follow up on breaches of regulations identified at our previous inspection, and to review the actions taken by the practice. We saw that appropriate and sufficient action had been taken to comply with the requirements of the regulations.

The practice is now rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. As we have now rated the practice as good for providing safe and well-led services, this has revised the rating for the six population groups, as follows:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

• The practice had carried out: a fire risk assessment; infection prevention and control audit; and legionella risk assessment, and acted upon any recommendations.

• It had re-stocked its emergency-use medicines cabinet, and instituted regular checking to ensure that all emergency medicines remained in stock and in date.

• Staff treated patients with compassion, kindness, dignity and respect and involved them in decisions regarding their care and treatment.

• The practice had ensured that all staff had completed all necessary training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We did not speak with patients as part of this inspection. We carried out this inspection to check that Charlton House Medical Centre had taken action to address areas of non-compliance we found at our last inspection.

At our previous inspection of 03 and 08 October 2013 we found that Charlton House Medical Centre did not have suitable arrangements in place to deal with foreseeable emergencies, to manage and minimise the risk of infection, and staff were not appropriately supported. Complaints were not appropriately managed, and people using the service, staff and visitors were not protected from unsafe and unsuitable premises.

The provider told us the actions they would take to address the non-compliance. When we inspected Charlton House Medical Centre on 13 August 2014, we found that many improvements had been made. However there were some outstanding actions relating to their maintenance of the premises.

We visited Charlton House Medical Centre over two days. We spoke with fourteen patients, two GPs, the practice manager, two receptionists, a secretary, the practice nurse and the health care assistant. This report states that Dr Morrison and Dr Ranmuthu are the registered managers. Dr Morrison, in fact, retired a few days before our inspection. His name appears in the report because it remained on our register at the time of our inspection.

People we spoke with said "the doctors are polite and friendly", there were "no real problems", and they [the GPs] do their best". People told us they were treated with respect and were able to ask questions about their treatment. Where appropriate, consent was recorded in people's medical notes. There was information about the practice available in the reception area, the practice leaflet and on its website.

Some medication and equipment which would be used in emergencies were out of date. Staff did not have up to date infection control training and there had not been any recent internal audits of infection control. An external audit of the premises had been carried out in 2012 but recommendations made regarding improving the premises not been followed up. Staff had not received regular training or appraisals to support them in their professional development.

There was a complaints policy and there was information in the waiting room about accessing the Patient and Advice Liaison Service (PALS) and the NHS Complaints Advocacy Service. However we found that some complaints had not been investigated in accordance with the practice's complaints policy.