Letter from the Chief Inspector of General Practice

East Quay Medical Centre is a suburban practice providing primary care services to patients resident in Bridgwater, Somerset. The practice has a patient population of approximately 14600. Before visiting, we reviewed a range of information we held about the practice and asked other organisations to share what they knew. This included the Somerset Clinical Commissioning Group (CCG), NHS England and Healthwatch.

We undertook a comprehensive announced inspection on 11 November 2014. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector, an expert by experience and a GP specialist advisor.

Overall the practice is rated as good. Specifically, we found the practice to be good for providing well-led, safe, effective, caring and responsive services. It was also good for providing services for all of the population groups.

Our key findings were as follows:

• Patients were able to get an appointment when they needed it.
• Staff were caring and treated patients with kindness and respect.
• Staff explained and involved patients in treatment decisions
• Patients were cared for in an environment which was clean and reflected good infection control practices.
• Patients were protected from the risks of unsafe medicine management procedures.
• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• The practice met nationally recognised quality standards for improving patient care and maintaining quality.
• The practice had systems to identify, monitor and evaluate risks to patients.
• Patients were treated by suitably qualified staff.
• GPs and nursing staff followed national guidance in the care and treatment provided.

We saw several areas of outstanding practice including:

• The practice employed specific staff to coordinate referrals and out patient appointments on behalf of the practice to benefit their patients. Patients gave us examples of the practice operating beyond their contractual obligations, for example, contacting hospital transport on behalf of patients and coordinating hospital appointments for patients.
• Information had been produced in an accessible format for patients with learning disabilities.
• The practice had an internal intranet system which was accessible by all staff which listed the operating policies and protocols for the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 11 November 2014– Good)

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 East Quay Medical Centre on 15 May 2018 as part of our inspection programme.

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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice supported research and invested time in participating in local and national pilots to improve care. For example, a self-referral physiotherapy service, enabling access for patients with a diabetes secondary care practitioner, virtual cardiology clinics and visiting paediatrician clinics.
• The practice invested in continuing to provide the service of the NHS Navigator role to support patients’ access the right care and support.
• The practice worked with the other members of the federation to invest in the Village Agent to support patients in the community.
• The partners at the practice held personal lists of patients which supported continuity of care for patients.
• GPs and the practice manager took on other roles outside of the practice to enhance their knowledge and skills to share and bring back to the practice. This was through taking on lead roles with the clinical commissioning group, Somerset Primary Healthcare, GP training and the Local Medical Committee.

We saw areas of outstanding practice:

• A new ‘drop in’ session has been developed for patients with memory loss and dementia.
• The practice manager created an open link via telephone or email for patients who need extra emotional support. This helped patients when they were anxious and enabled some issues to be addressed in advance or de-escalate concerns that they may have.
• Staff encouraged and supported patients to be involved in monitoring and managing their own health, for example, through social prescribing schemes and local initiatives. These included health walks, pilots for diabetes self-care. The practice was working on a mentor scheme with personal trainers through the Somerset Activity & Sports Partnership to help support young people with self-worth issues join in physical activities.

The areas where the provider should make improvements are:

• The practice should continue to monitor that the Patient Group Directions (PGDs) for vaccines and immunisation documentation to support staff to deliver treatment is complete and up to date.
• The practice should continue to monitor the new system and process for the safe management of prescription paper and pads that was implemented during the inspection is appropriately implemented.
• The practice should include clearer information in the infection control audit could as to why aspects of the audit tool do not apply. For example, the type of hand wash facilities available did not match current good practice guidelines for public or clinical areas.

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