Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Danebridge Medical Practice. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring, safe and responsive services. It was also good for providing services to meet the needs of all population groups of patients. We found that some improvements should be made to record keeping in relation to the safety of the service.

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

• There were systems in place to protect patients from avoidable harm and abuse. Staff were aware of procedures for safeguarding patients from risk of abuse. There were clear processes in place to investigate and act upon any incident and to share learning with staff to mitigate future risk. There were appropriate systems in place to protect patients from the risks associated with medicines. The staffing numbers and skill mix were reviewed to ensure that patients were safe and their care and treatment needs were met. We found improvements should be made to the records for staff recruitment and the management of medical equipment.

• Patients care needs were assessed and care and treatment was being considered in line with best practice national guidelines. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed.

• Feedback from patients showed they were overall happy with the care given by all staff. They felt listened to, treated with dignity and respect and involved in decision making around their care and treatment.

• The practice planned its services to meet the differing needs of patients. The practice encouraged patients to give their views about the services offered and made changes as a consequence.

• There was a clear leadership structure in place. Quality and performance were monitored, risks were identified and managed. The practice ensured that staff had access to learning and improvement opportunities.

There were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Make a record of the physical and mental fitness of staff during the recruitment process.

• Review the system at Kingsmead Medical Centre for ensuring defibrillator pads and oxygen masks for children are immediately accessible to staff in an emergency.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with nine patients who told us they were happy with the consultations they had with their GP. They said they had time to discuss their concerns during the consultation and that treatment, tests and test results were generally explained to them. They said that where needed they were given written information about health conditions. Five of the nine patients spoken with said it was sometimes difficult to get through to the service by telephone. Some comments made were:-

“I have every confidence in my GP they listen to me and believe me. They have always explained any treatments or change in medication really well and have given me information leaflets for me to take home.”

“I came in today to have an annual review they sent a reminder to me and when I rang them they were happy to accommodate a time that was better for me. My doctor takes the time to explain things to me which reduces my stress levels.”

“I have needed a lot of tests done and have had a lot of appointments with my GP they have made double appointments so that I don’t feel rushed. I really feel that they care about me.”

We found that patients were respected and involved in the service provided to them.

There were practices in place to ensure patients experienced care and treatment that met their needs.

Appropriate measures were in place to ensure vulnerable adults and children would be protected from abuse.

We found that the service had quality assurance systems to ensure patients were protected from risks to their health, welfare and safety.

We rated the practice as good for providing caring, effective and responsive services because:

• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• 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.

We rated the population groups as good.

The area where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure specified information is available regarding each person employed or appointed.
• Ensure specified information is referred to CQC in accordance with the (Registration) Regulations 2009.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Introduce a system to monitor two-week rule referrals to ensure patients receive the clinical care they are referred for.
• Review the security of NHS prescriptions in the practice and ensure there are systems in place to track and monitor their use.
• Make a record of the stock levels and expiry dates of emergency medicines contained within GP bags.
• Introduce a system for the regular cleaning of carpeted areas at Sandiway.
• Introduce a system to check infection control standards are being maintained in between annual audits, to record spot checks of the cleaning undertaken by the cleaners and to record when equipment such as nebulisers are cleaned.
• Introduce a system to audit patient consent to check this is being appropriately sought and recorded.
• Introduce a comprehensive programme of quality improvement and use this information about care and treatment to make improvements.
• The remit for referrals to the self-employed counsellors to be documented.
• The written agreement between the counsellor, practice and patient to clearly identify what information is to be recorded, where it is to be stored and who has access to this information.

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