We carried out an announced comprehensive inspection at Dr Rachael Garner (Notting Hill Medical Centre) on 4 August 2015. The overall rating for the practice was good with requires improvement in providing safe services. The full comprehensive report on the 4 August 2015 inspection can be found by selecting the ‘all reports’ link for Dr Rachael Garner on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 22 February 2018 to confirm that the practice had carried out their plan to meet the requirements that we identified in our previous inspection on 4 August 2015. This report covers our findings in relation to those requirements and any improvements made since our last inspection.

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

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 addressed the findings of our previous inspection in respect of actioning the findings of a Legionella risk assessment and the safe storage and usage of liquid nitrogen.
• There were systems in place to safeguard children and vulnerable adults from abuse and staff we spoke with knew how to identify and report safeguarding concerns.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. 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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Results from the national GP patient survey showed patients rated the practice comparable with others for aspects of caring. Patients told us they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice reviewed the needs of its local population and engaged in local health initiatives to improve patient outcomes.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review the NICE Guidelines NG51: Sepsis Recognition, Diagnosis and Early Management and consider if the practice can appropriately assess all patients, including children, with suspected sepsis.
• Review the fire evacuation procedure.
• Review the requirements of the Accessible Information Standard.
• Continue to monitor satisfaction feedback with respect to how patients access care and treatment.

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 the Notting Hill Medical Centre on 04 August 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns and, there was an open and transparent system for reporting incidents and near misses in place. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• After bank holidays the practice ensured that there were more same day appointments available for patients’. Children under 5 years or patients over 80 years could access same day appointments.
• There was a triage system in place which was managed by the duty doctor to prioritise assessment and meet patients’ needs.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• Patient’s needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles. The practice worked collaboratively with other local providers to improve patient outcomes. For example the practice worked as part of an integrated service providing joint clinics with a paediatrician.
• The practice implemented suggestions for improvements and made changes to the way to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

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

Importantly the provider must:

• The practice had a legionella risk assessment completed in March 2015, which identified actions that needed to be completed to mitigate risk. The practice must ensure all actions that were identified were responded to in a timely manner.
• Review the system in place for the use and storage of liquid nitrogen to ensure that the practice is fully compliant with the guidance, including a risk assessment Control of Substances Hazardous to Health (COSHH).
• Ensure that the COSHH risk assessments are accessible for all staff. We were unable to review the COSHH folder which was not available to be seen during the inspection.

Importantly the provider should:

• Ensure all electrical equipment had portable appliance testing (PAT) completed and that equipment is tested at the recommended frequency.

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure that all actions identified to mitigate risk were responded to in a timely manner.
• Ensure that information to help patients understand the complaints procedure was not contradictory.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice