This practice is rated as requires improvement overall.

(At the previous inspection in February 2015 the practice was rated as good overall but the safe domain was rated as requires improvement).

The key questions are rated as:

Are services safe? - Requires improvement

Are services effective? - Requires improvement

Are services caring? - Good

Are services responsive? - Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Geraldine Golden & Dr Michael Abu (locally known as Kenton Bridge Medical Centre) on 19 April 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Dr Geraldine Golden & Dr Michael Abu was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• Risks to patients were assessed and well managed in some areas, with the exception of those relating to fire safety and management of blank prescription forms.
• The practice was unable to provide documentary evidence to demonstrate that all staff had received training relevant to their role.
• There was some evidence of quality improvement activity including the clinical audit.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients we spoke with found the appointment system easy to use and reported that they were able to access care when they needed it.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The practice was aware of and complied with the requirements of the Duty of Candour.
• 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.

We saw some areas of outstanding practice:

• The practice was working in partnership with a local substance misuse service and provided regular specialist clinics every second Wednesday. In the last two years, the practice had provided person centered care to 12 patients on the substance misuse register. The practice had developed person centered care plans and regularly reviewed care plans for every patient once a month during face to face appointment. We saw evidence that the practice had implemented the care plans effectively and after two years 10 patients had been removed from the register and two other patients were making steady progress on their reduction care plan due to continuity in planning and delivering patient care. Patients were able to attend weekly pre-arranged sessions with a doctor who specialises in psychology.
• The practice was offering out of hours service to 60 older patients at a local nursing home 365 days a year between 8am and 10pm without any additional funding. One of the GP partners from the practice visited the home weekly and offered a consultation for between 15 and 20 patients. The practice had a protocol in place with the nursing home and the nursing staff were able to contact the practice and request a telephone consultation or a home visit between 8am and 10pm from Monday to Sunday.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure persons employed in the provision of the regulated activity receive the appropriate training and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Ensure all necessary recruitment checks are in place and records kept in staff files including proof of identification, entitlement to work in the UK and Disclosure and Barring Scheme (DBS) checks.
• Ensure all staff have received formal sepsis awareness training.
• Implement quality improvement initiatives which may include clinical audit.
• Ensure information about a translation service is displayed in the reception area informing patients this service is available. Ensure information posters and leaflets are available in multiple languages.
• Ensure the complaint policy and procedures are up to date and a response to complaints includes information of the complainant’s right to escalate the complaint to the Ombudsman if dissatisfied with the response.

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 on 04 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It required improvement for providing safe services. The practice was also good for providing services for older people, people with long term conditions, families children and young people, working age people including those recently retired, people whose circumstances make them vulnerable, and people experiencing poor mental health (including those with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• 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.

We saw one area of outstanding practice:

• The practice offered special clinics for patients with addictions and worked closely with a local susbstance misuse service. Patients were able to attend weekly pre-arranged sessions with a psychologist.

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

Importantly the provider should

• Ensure a record is made of learning from incidents and significant events.

• Ensure recruitment arrangements include all of the necessary employment checks for staff.

• Ensure the role of non-clinical staff is risk assessed and Disclosure and Barring Checks are carried are carried out as required. The practice should undertake a risk assessment to determine which non clinical members of staff are eligible for a Disclosure and Barring Check as determined by their role in patient care.

• Ensure training is provided on the role of chaperone.

• Ensure that the management of vaccines is consistent with the cold chain ‘policy’.

• Ensure there is a system to call for assistance in an emergency.

• Ensure audit cycles are completed to drive continual improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice