Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of East Lynne Medical Centre on 28 October 2015. The practice was rated inadequate overall.

We undertook a comprehensive follow-up inspection of East Lynne Medical Centre on 31 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection. The practice was rated as good overall with requires improvement for responsive services.

The full comprehensive and follow-up reports following the inspections can be found by selecting the ‘all reports’ link for East Lynne Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused follow-up inspection carried out on 26 September 2017 to check that the practice had made sufficient improvements as identified in the last inspection on 31 January 2017. We also needed to monitor and consider anonymous concerns and complaints we had received since the previous inspection on 31 January 2017.

Our key findings were as follows:

• Work had been carried out to understand and improve the appointment making process at the practice. However, patient satisfaction in the July 2017 GP national survey remained extremely low compared to local and national practices.
• There was an action plan to review exception reporting within the Quality and Outcome Framework (QOF) work.
• Nursing staff had been given more responsibilities to carry out long-term condition management reviews.
• A new process monitored concerns and complaints raised verbally.
• Audits and practice patient surveys were used to monitor patient feedback.
• A protocol had been implemented to review vulnerable children and adults that had not attended their hospital or follow-up appointments.
• Patients said they were concerned by the lack of GPs working at the practice. Patients told us that when a nurse or GP asked them to book a follow-up appointment they found none available.
• Patients also said they were also concerned about no continuity of care provided by GPs.
• Patients accessing the practice by telephone told us on the day of inspection it was difficult.

Actions the practice must take to improve:

• Establish systems or processes to enable the registered person to seek and act on feedback from patients and staff on the services provided in the carrying on of the regulated activities, to continually evaluate and improve services.

Actions the practice should take to improve:

• Improve exception reporting rates.

Consequently, the practice is still rated as requires improvement for providing responsive services.

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 East Lynne Medical Centre on 31 January 2017. This inspection was a follow up to our previous comprehensive inspection at the practice on 28 October 2015 where breaches of regulation had been identified. The practice was formally known as Dr S Sherwood and Partners and the management of the practice had changed in August 2016. The overall rating of the practice following the 28 October 2015 inspection was inadequate and the practice was placed into special measures for a period of six months.

At our inspection on 31 January 2017 we found that the practice had improved. The ratings for the practice have been updated to reflect our recent findings. The practice is rated as good for providing safe, effective, caring and well led services. It is rated as requires improvement for providing responsive services.

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.
• The practice had implemented new systems and processes to ensure that risks to patients were assessed and well managed.
• Extensive work had been undertaken to ensure that there was an effective system in place to support patients who were prescribed medicines that required monitoring. Furthermore, a protocol had been developed to ensure that reviews of safety updates from the Medicines and Healthcare Products Regulatory Agency (MHRA) were undertaken.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Formal governance arrangements had been instigated to monitor the quality of the service provision.
• Feedback from patients about their care was generally positive. Patients said they were treated with compassion, dignity and respect, and that clinical staff took their concerns seriously.
• However, we received negative feedback relating to the appointments system used at the practice. The practice recognised that there was progress to be made in this area, and were working with the wider health community to address the issue.
• Information about services and how to complain was available and easy to understand. However, not all verbal complaints were reported to the management team. This meant that it was difficult to identify trends in verbal complaints and make improvements where required.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Policies and procedures had been reviewed and updated to reflect the requirements of the practice.
• There was a clear leadership structure in place and staff felt well supported by the GP partners and management team. Staff were encouraged to provide feedback at monthly whole team meetings and had regular appraisals.

The areas where the provider should make improvements are:

• Improve processes for making appointments.
• Review the way exception reporting is used.
• Record, monitor and action concerns raised in verbal complaints.
• Continue to monitor patient feedback.
• Implement a protocol for reviewing children who do not attend hospital appointments.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 East Lynne Medical Centre on 31 January 2017. This inspection was a follow up to our previous comprehensive inspection at the practice on 28 October 2015 where breaches of regulation had been identified. The practice was formally known as Dr S Sherwood and Partners and the management of the practice had changed in August 2016. The overall rating of the practice following the 28 October 2015 inspection was inadequate and the practice was placed into special measures for a period of six months.

At our inspection on 31 January 2017 we found that the practice had improved. The ratings for the practice have been updated to reflect our recent findings. The practice is rated as good for providing safe, effective, caring and well led services. It is rated as requires improvement for providing responsive services.

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.
• The practice had implemented new systems and processes to ensure that risks to patients were assessed and well managed.
• Extensive work had been undertaken to ensure that there was an effective system in place to support patients who were prescribed medicines that required monitoring. Furthermore, a protocol had been developed to ensure that reviews of safety updates from the Medicines and Healthcare Products Regulatory Agency (MHRA) were undertaken.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Formal governance arrangements had been instigated to monitor the quality of the service provision.
• Feedback from patients about their care was generally positive. Patients said they were treated with compassion, dignity and respect, and that clinical staff took their concerns seriously.
• However, we received negative feedback relating to the appointments system used at the practice. The practice recognised that there was progress to be made in this area, and were working with the wider health community to address the issue.
• Information about services and how to complain was available and easy to understand. However, not all verbal complaints were reported to the management team. This meant that it was difficult to identify trends in verbal complaints and make improvements where required.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Policies and procedures had been reviewed and updated to reflect the requirements of the practice.
• There was a clear leadership structure in place and staff felt well supported by the GP partners and management team. Staff were encouraged to provide feedback at monthly whole team meetings and had regular appraisals.

The areas where the provider should make improvements are:

• Improve processes for making appointments.
• Review the way exception reporting is used.
• Record, monitor and action concerns raised in verbal complaints.
• Continue to monitor patient feedback.
• Implement a protocol for reviewing children who do not attend hospital appointments.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice