Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Claremont Medical Centre on 18 October 2016. 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. When a significant event occurred it would be discussed and notes of the discussion and agreed actions were kept; however, although there was a significant event recording form available for staff to complete, this was not used consistently.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance; safety alerts and guidance updates were distributed to relevant staff; however, no log was kept of the action taken as a result.
• Data showed patient outcomes were better than the national average; however, the practice had excepted a higher than average proportion of patients from Quality Outcomes Framework indicators, but were unaware of this. We checked a sample of records of patients who had been excepted from diabetes indicators and found that in all cases the reason for the patient being excepted was clinically appropriate.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Overall, 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; however, some patients said that they found it difficult to get through to the practice by phone. The practice was in the process of promoting their online booking system, and felt that as the online system became more popular, telephone access for those patients who chose not to book appointments online would improve.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw one area of outstanding practice:

The practice employed a part-time counselling co-ordinator whose role was to liaise with local training providers to arrange for their counselling students to provide a service to the practice’s patients. Students provided this service on a voluntary basis as part of their training, and were supervised by their university tutors or the counselling co-ordinator. In total 110 hours of counselling per week was provided to the practice’s patients via this scheme, and on average patients who were referred received a course of 12 sessions.

The areas where the provider should make improvement are:

• They should ensure that their record-keeping processes are effective, including those for reporting and recording significant events, logging stocks of prescription sheets, recording verbal complaints, and logging action taken following the receipt of safety alerts and updates.
• They should review their rate of exception reporting from Quality Outcomes Framework indicators to assess whether there are areas where patient care can be improved.
• They should review their appointment booking system to identify whether any changes could be made to improve telephone access to the practice.
• They should ensure that their recruitment policy is sufficiently detailed with regards to pre-employment checks.
• They should ensure that they are managing the risk of Legionella.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice