Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cornerways Medical Centre on 11 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 and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and managed. However some of the systems and process in place to monitor risk needed to be reviewed for example, safeguarding systems and the systems used to process medication requests and changes and the monitoring of uncollected prescriptions. Following the inspection the practice provided evidence that showed the current systems had been reviewed and changes made.
• 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.
• 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.
• 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.
• 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 (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).

The areas where the provider should improvement are:

• The systems put in place to monitor safeguarding and medicines management information should be reviewed to ensure the processes are embedded to improve the safety and quality of the service provided.

• The recruitment system should be regularly audited to ensure all required information concerning staff contracted to work at the practice is in place.

• The clinical audit programme should continue to be developed to support continued quality improvement in the treatment and care provided to patients.

• The internal appraisal system and training plan for clinicians should be monitored to ensure they have the necessary skills and competencies to carry out their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our previous inspection in February 2014 we identified concerns relating to insufficient staffing for the administration and receptionist roles at the practice. The provider sent to us a robust action plan following our visit. This inspection was a follow up inspection to review the progress made with the action plan and the improvement CQC required the provider to make. We found an increase in numbers of staff for these roles and a positive impact for how the practice was now able to meet the needs of the local population. We did not speak with patients during this inspection.

During this inspection we looked at how well patients understood the care and treatment they were given. We spoke with a number of patients attending the practice. Generally they reported good access to care and treatment. One patient told us, "Staff are always helpful and willing to give appointments at short notice, they are lovely and very friendly."

We looked in particular at how the practice manages the care of patients with long term chronic and mental illnesses. We found that the GP’s and Practice Nurse managed the majority of care provided to these patients but they worked alongside specialists not directly employed by the practice.

We looked at the skill mix of staff that worked at the practice. We observed administration staff, nurses, doctors and management staff. We considered that overall staff had the right knowledge, experience and skills needed to undertake their roles however we were not assured that there were sufficient numbers of administration staff employed to effectively support the practice.

We found that staff received appropriate professional development and they were

supported from time to time to obtain further relevant qualifications. We found the Practice Manager maintained good systems of quality monitoring and patient safety.

We looked at the skill mix of staff that worked at the practice. We found administration staff, nurses, doctors and management staff. We considered that overall staff had the right knowledge, experience and skills needed to undertake their roles however we were not assured that there were sufficient numbers of administration staff employed to effectively support the practice.

We found that staff received appropriate professional development and they were

supported from time to time to obtain further relevant qualifications. We found the Practice Manager maintained good systems of quality monitoring and patient safety.

We carried out an announced comprehensive inspection at Cornerways Medical Centre on 27 February 2019 in response to monitoring data and information from a stakeholder which raised concerns about staff numbers and skill mix.  

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We rated the provider as good for providing safe, effective, caring, responsive and well-led services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs. There sufficient numbers of suitably trained and experienced clinical and managerial staff. The provider had reviewed front-of-house staffing and additional reception and administration staff were being employed to ensure the needs of staff and patients were met.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice was managed by a management leadership team which included professional finance, marketing and communication and quality assurance personnel. This team had developed an infrastructure which supported innovative ways of working; promoted sustainable improvements and high-quality care in all outcome areas.
• One example of innovation is that the provider had developed a charity linked to the practice which worked with local voluntary organisations, to develop and provide services that could help prevent illness caused by debt, social isolation and other non-medical issues. The practices in the group could refer patients directly into these services.
• The culture of the practice meant all stakeholders, including hard to reach groups could access the service or participate in planning changes.

Whilst we found no breaches of regulations, the provider should:

• Review the response to public comments made on the NHS Choice website.
• Review how mentoring for advanced nurse practitioners.
• Review the readiness of information about the immunisation status and medical indemnity cover of staff.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice