Letter from the Chief Inspector of General Practice

During our comprehensive inspection of Crescent Bakery in June 2016 we found breaches of legal requirements relating to the overview of safety systems and processes; management, monitoring and improving outcomes for people and governance arrangements. These resulted in the practice being rated as requires improvement for the provision of safe, effective and well led services. Specifically we found the practice:

• Did not take appropriate actions when vaccine fridges were operating outside of the required range.

• Had not ensured all staffhad the required pre-employment checks.

• Had nationally reported outcomes for patients with long term conditions that were below average. Patients with these conditions may not have been receiving the reviews of their treatment to ensure their care was maintained.

• Did not ensure all staff have had an appraisal.

• Did not have a continuous programme of audits to ensure quality improvements.

The practice sent us an action plan setting out the changes they were making to address the issues that led to our concerns.

We carried out a focused inspection on 1 December 2016 to ensure these changes had been implemented and that the service was now meeting the regulations. The ratings for the practice have been updated to reflect our findings. We found the practice had made improvements in the safe and effective provision of services since our last inspection on 1 June 2016 and they were meeting the requirements of the regulations previously breached.

Specifically the practice had:

• Introduced stricter controls in monitoring vaccine fridges and had updated relevant staff on the correct procedures for checking and resetting of vaccine fridge thermometers.

• Completed Disclosure and Barring Service (DBS) check for staff who required these. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

• Improved their systems to complete reviews of the care of patients with long term conditions. Data for the first eight months of the recording period in 2016/17 showed improved outcomes for these patients.

• Ensured all staff have had an appraisal.

• Introduced a programme of audits and undertaken re-audits to ensure quality improvement.

Additionally,

• All staff have undertaken Safeguarding adults training.

• Actions had been taken to improve patient’s satisfaction on consultation with GPs and nurses.

We have updated the ratings for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective and well led services.

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 Crescent Bakery on 1 June 2016. Overall the practice is rated as requires improvement.

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.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe.
• 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. However, GP patient survey result on consultations with GPs and nurses were lower than the clinical commissioning group and national averages.
• 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 areas where the provider must make improvement are:

• Ensure appropriate actions are taken when vaccines fridges are operating outside of the required range.

• Ensure all staff have had the required pre-employment checks.

• Ensure the number of reviews for patients with long term conditions is increased and the outcomes of the reviews are appropriately and accurately recorded in the patient’s medical records.

• Ensure all staff have had an appraisal.

• Ensure a continuous programme of audits is maintained to ensure quality improvements.

The areas where the provider should make improvement are:

• Ensure all staff have received safeguarding adults training.

• Ensure actions are taken to improve patient’s satisfaction on consultation with GPs and nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice