Derby Medical Centre was previously inspected in November 2014 and December 2015 and was rated good overall and in all domains.

At this inspection in May 2018 the practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Derby Medical Centre on 23 May 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice used their knowledge of the local community and patient population as levers to deliver high quality and person centred care.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• There was a strong focus on improvement at all levels of the organisation.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff were supported in personal development and training and received regular appraisals.
• Data from the Quality and Outcomes Framework (QOF) showed the results for practice management of patients with long-term conditions were good.
• Information about services and how to complain was available and easy to understand.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments and home visits were available. Urgent appointments for those with enhanced needs were also provided the same day.
• The practice was equipped to treat patients and meet their needs.
• The practice offered personal lists which ensured good continuity of care.

The areas where the provider should make improvements are:

• Consider why health reviews for patients with learning disabilities are low and how this could be improved.
• Investigate any learning where exception reporting for certain areas of QOF are higher than national averages and how this could be improved.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

The practice is rated Good overall and is now rated Good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 18 November 2014. Breaches of legal requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. As a result, we undertook a desk based focused inspection on 14 December 2015 to follow up on whether action had been completed to deal with the breaches.

During our previous inspection on the 18 November 2014 we found the following areas where the practice must improve:-

• Assess the risk of using staff as medical chaperones who had not received a criminal record check undertaken with the Disclosure and Barring Service (DBS).
• Keep records of registration checks undertaken with professional bodies for relevant staff.

Our previous report also highlighted areas where the practice should improve:-

• Provide appropriate training to non-clinical staff who act as medical chaperones.
• Ensure that performance, quality and risks are discussed and assessed on a regular basis and that records of this are kept.
• Put agreed systems in place for recording significant events and safety alerts in a consistent format in order to demonstrate what lessons have been learned, how these have been shared with staff and what action has been taken as a result.
• Put a system in place that ensures practice policies and procedures are up to date and that current and previous versions are clearly identifiable.
• Put measures in place to ensure that patients who present at the reception desk in the waiting area are not asked to divulge confidential or sensitive information, which can be overheard by other patients.
• Clarify the leadership structure so that lead roles and responsibilities are clearly identifiable.

We conducted a desk based focused inspection on 14 December 2015 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. (A desk based focused inspection means the provider was able to send us evidence of the action taken to address the issues previously found rather than visiting the practice).

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During this inspection we found:-

• All staff who undertook chaperone duties had received a criminal record check via the Disclosure and Barring Services (DBS) and had taken part in chaperone training
• The practice retained records of the registration checks undertaken with professional bodies for clinical staff.

We also found in relation to the areas where the practice should improve:-

• The practice was able to evidence that significant events were now being recorded onto a
• The practice could evidence that safety alerts were disseminated by the practice manager and saved on to the practice computer system.
• The practice had put in place a new system for their electronic policies and could evidence these were up to date.
• The practice had moved the main switchboard away from the front desk so that patients did not overhear private conversations and had made available a small room that staff could offer to patients if they wanted to discuss confidential or private information. There was also on display a notice informing patients of this choice.
• The practice was able to send us a leadership structure chart, which was displayed on the staff notice board.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of The Derby Medical Practice on 18 November 2014.

We have rated the practice as good. We found that the practice provided an effective, caring and responsive service to patients. However improvements were required in relation to safety. There was a strong ethos of providing continuity of care and the practice maintained a personal list system in response to patient preference for this. All of the staff we spoke with were committed to providing a caring service and they all felt well supported in their roles. Patient feedback was consistently positive.

Our key findings were as follows:

• Each GP had their own personal list to ensure that patients always saw the same GP to ensure continuity of care.
• Systems were in place to ensure high standards of cleanliness and infection control and patients said the practice was always clean and tidy.
• Patients described the service they received as excellent. Staff were described as helpful, caring, supportive and respectful.
• The practice was responsive to the particular patient needs of its registered population. For example, because of the large number of students on its register, practice staff spent three days on local college sites registering students and providing them with an extensive range of health advice and literature.
• Records for the purpose of managing the practice were not always maintained.
• Some patients commented that confidential conversations at the reception desk in the waiting area could easily be overheard.

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

Importantly, the provider must:

• Assess the risk of using staff as medical chaperones who had not received a criminal record check undertaken with the Disclosure and Barring Service (DBS).
• Keep records of registration checks undertaken with professional bodies for relevant staff.

In addition, the provider should:

• Provide appropriate training to non-clinical staff who act as medical chaperones.
• Ensure that performance, quality and risks are discussed and assessed on a regular basis and that records of this are kept.
• Put agreed systems in place for recording significant events and safety alerts in a consistent format in order to demonstrate what lessons have been learned, how these have been shared with staff and what action has been taken as a result.
• Put a system in place that ensures practice policies and procedures are up to date and that current and previous versions are clearly identifiable.
• Put measures in place to ensure that patients who present at the reception desk in the waiting area are not asked to divulge confidential or sensitive information which can be overheard by other patients.
• Clarify the leadership structure so that lead roles and responsibilities are clearly identifiable.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice