Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 23 November 2017 to follow up on breaches of regulations identified in our inspection in April 2017.

This practice is rated as Good overall. (At the previous inspection on 26 April 2017 the practice was rated as requires improvement in safe, caring and responsive with good in effective and well led; with an overall rating for the practice of requires improvement). Although the practice had taken action to address areas for improvement it was too soon for the outcome of these actions to demonstrate impact, such as improvements to telephone access. The practice is still rated as requires improvement for providing responsive services.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

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

At this inspection we found:

• The practice had systems and processes to minimise risks to patient safety. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and outcomes had been actioned.
• The system for recording, actioning and tracking patient safety alerts had been improved and demonstrated that all alerts had been reviewed and action taken where appropriate. All alerts were reviewed in clinical meetings.
• All appropriate recruitment checks had been carried out on staff prior to being employed by the practice. This included medical indemnity checks carried out on locum GPs employed.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This included appropriate arrangements for equipment and medicines that may be required to respond to a medical emergency.
• Information about services and how to complain was available to patients. The practice made improvements to the quality of care as a result of learning from complaints and concerns.
• There was a practice development plan that documented both their long and short-term priorities. This included actions they had taken in response to patient feedback about the difficulty in accessing appointments, and the plans for continued improvements.
• The practice had visible clinical and managerial leadership with audit arrangements in place to monitor quality.

There were areas where the provider should make improvements:

• The practice should continue to work towards improving access and measure the impact of changes to improve it.

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 Croft Medical Centre on 26 April 2017. Overall the practice is rated as Requires Improvement.

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

• The practice had defined systems and processes in place to minimise risks to patient safety and we found there was an effective system in place to demonstrate what action had been taken with safety alerts received including alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).

  However, we did find that a gap in the administrative process and actions taken were not always recorded. We found evidence of one alert that had not been actioned. Since the inspection we have received evidence to confirm that the alert had been acted on and we also received assurances that alerts have been added as a fixed agenda item for discussion at all clinical meetings.

• The practice had some immunisation records for staff, but we found there was no system in place to ensure all staff were up to date with routine immunisations and no risk assessments had been completed in the absence of staff immunisation status to identify duties, risks and actions to minimise the risk to staff.

• There was an open and transparent approach and a system in place for reporting and recording significant events and incidents.
• The practice had adapted the long term conditions clinical templates to suit their practice population to ensure the needs of the patients were being met.
• Events had been organised by the practice to promote awareness and to support patients who were undergoing treatment, this included a breast friends event for patients with breast cancer and their families.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and 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.
• Patient feedback from CQC comment cards and patients we spoke with was positive about the care received. However, the latest national patient survey showed scores were lower than other practices locally and nationally for access to appointments. The practice had acted on this feedback with continual review and had made changes to the appointment system in order to improve access. Appointments were available on the day of our inspection.
• The practice encouraged staff to develop their roles and one of the practice nurses had been a finalist for the Solihull Together Awards, Health Professional of the year. This was due to undertaking cancer care reviews to support patients with any issues relating to their care and treatment. The practice nurse held clinics once a week for patients undergoing treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Due to the resignation of two GPs, the practice had increased the number of staff in the nursing team and had employed two nurse prescribers to support the clinical team.
• 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 the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure risk assessments have been undertaken in the absence of staff immunisation status to identify duties, risks and actions to minimise the risk to staff.
• Seek patient views and act on feedback to evaluate and improve services and telephone access.

The areas where the provider should make improvements are:

• Review current processes for identifying carers and information available to encourage patients to notify the practice if they are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice