Letter from the Chief Inspector of General Practice

We carried out a focussed review inspection at Dr Peter Gini also known as Broadway Health Centre on 22 July 2016. The practice had previously been inspected in June 2015 and was rated as requires improvement for providing effective services. Staff performance and training needs were not identified and documented through a regular programme of annual appraisals for nursing staff. Following the inspection the practice sent us an action plan detailing the action they were going to take to improve.

We returned to the practice to consider whether improvements had been made in response to our previous inspection. We found the practice had made improvements and is now rated as good for providing effective services. This report should be read in conjunction with our previous inspection report for the practice.

Overall the practice is rated as good.

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

• Staff performance and training needs reviews were being carried out through a regular programme of annual appraisals.

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 Dr Peter Gini, Broadway Health Centre on 23 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, caring, responsive and well-led services. The practice was requires improvement for proving effective services. It was also good for providing services for the care of older people, people with long term conditions, families children and young people, w

orking age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• 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.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Risks to patients were assessed and well managed and information about safety was recorded, monitored, appropriately reviewed and addressed.

• The practice frequently met with other organisations including district nurses, health visitors, social services, school nurses and midwives to discuss patients with complex needs and to ensure that they meet people’s needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• There was a clear leadership structure and staff felt supported by management.

We saw an area of outstanding practice:

• The practice had started to address their low vaccination rates by developing a vaccine preventable illness plan which included offering flu jabs at a local homeless shelter and providing additional walk in clinics for patients to attend after working hours.

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

Importantly the provider should:

• Ensure staff performance and training needs are identified and documented through a regular programme of annual appraisals and ensure these are completed for nursing staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our last inspection in September 2013, we found the arrangements to safeguard vulnerable patients from harm were not robust. There was no up to date policies and procedures in place to guide staff and staff had not received training in safeguarding vulnerable adults and children. At the time of the inspection, we judged that this had a moderate impact on patients who used the service. We set compliance actions and told the provider to take action.

The purpose of this inspection was to see if improvements had been made since our last inspection in September 2013. We gave the provider short notice so that any disruption to patients care and treatment was minimised. During our inspection we spoke with four members of staff including practice manager. We found that the provider had made the necessary improvements.

Patients privacy and dignity were respected.

There were arrangements in place to deal with foreseeable emergencies.

Vulnerable patients were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider had appropriate arrangements in place to manage medicines.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients and others.

During our inspection we spoke with seven patients who used the service including two members of the practice’s Patient Participation Group. We also spoke with five clinical and administrative members of staff. This included a GP who was also the registered provider and the practice manager who worked part time at the practice.

Patients spoken with were generally positive about the care and treatment they received. They told us that they were treated with dignity and respect and that any long term health conditions they had were kept under review. Comments received from patients included: “As far as I am concerned the whole practice is pretty good” and “I have had occasions where I have needed to see a doctor urgently and I have had no problems getting an appointment.”

Patients were protected from the risks associated with medicines. Medicines were stored appropriately. Patients on long term medication underwent medicine reviews and had no difficulties obtaining repeat prescriptions.

We found the arrangements to safeguard patients from harm were inadequate. There were no clear processes in place for identifying and reporting patients at risk of harm. Policies and procedures were out of date.

Quality monitoring systems were in place but these were not always systematic. We found not all staff had formal opportunities to raise issues or receive updates about the service. There were no clear processes for reporting incidents that occurred and health and safety checks were not recorded.

The practice was not currently registered for the regulated activity of 'diagnostic or screening procedures'. The provider was aware they needed to do this as soon as possible.