Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. We previously inspected the service in July 2015 and rated the practice as Good overall with outstanding in providing a responsive service.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

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

We carried out an announced comprehensive inspection at Charlton Medical Centre on 20 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice had clear systems to keep patients safe and safeguarded from abuse.

• There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff.

• 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.

• The practice had purchased an ultrasound scanner to provide enhanced diagnostic facilities to their patients. The ultrasound scans were carried out by visiting sonographers employed by the local hospital trust.

• 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.

• Staff stated they felt respected, supported and valued.

• The practice listened and acted on issues raised by the patient participation group.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice had equipment that tested the C-reactive protein (CRP) in a patient’s blood at the point of consultation. This was used when infection was clinically suspected. Measuring the CRP in a patient’s blood in this way helped to differentiate between viral infections and more serious bacterial infections needing antibiotic prescribing.

• The practice had purchased a digital dermoscope (acts as an aid in the diagnosis of skin lesions). Images were reviewed weekly at the clinical meetings and referrals made to secondary care where needed, leading to timely intervention.

• The practice provided an enhanced service with a view of facilitating pre-diagnosis and support to people with dementia. The practice held a licence for the use of a tablet device application used to test for memory problems independent of language or educational attainment allowing diagnosis of early dementia. Due to this, the practice has seen an increase in the number of patients on the practice’s dementia register from 61 to 92 over the last year.

The areas where the provider should make improvements are:

• The practice should complete a written risk assessment to assess the need to stock medicines for the treatment of seizures as part of their emergency stock.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Charlton Medical Centre is located in Telford, Shropshire. We carried out an announced comprehensive inspection on 01 July 2015. Overall Charlton Medical Centre is rated as good.

Specifically, we found the practice to be good in caring, effective, safe and well-led services and outstanding in responsive. It was good for providing services for all the population groups.

Our key findings were as follows:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• Patients’ needs were assessed and care was planned and delivered after considering best practice guidance.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand

• The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

We saw several areas of outstanding practice including:

• The practice funded enhanced diagnostic services for their patients such as a heel scanner for diagnosis of osteoporosis, clinical photography, dermoscopy (acts as an aid in the diagnosis of skin lesions), sleep apnoea monitors (a sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep). This had improved diagnostic access for its patients.

• The practice provided an enhanced service with a view to facilitating timely diagnosis and support for people with dementia. The practice held a license for the use of a tablet device application used to test for memory problems independent of language or educational attainment with the potential for allowing diagnosis of early dementia and therefore in the implementation of care and treat accordingly.

• The practice had purchased an ultrasound scanner and this had improved diagnostic access for its patients. The practice together with the local hospital trust now staffed and managed this diagnostic facility from the practice for its patients and for other local practices.

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

The provider should:

• Complete a formal written risk assessment on the emergency medicines not held as stock within the practice.

• Complete an Infection and Prevention Control audit.

• Consider the inclusion of practice nursing staff in clinical meetings and whole staff meetings.

• Consider an evaluation of the additional services provided by the practice to its patients, in particular any impact on the delivery of patient care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice