Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastwick Park Medical Practice on 10 September 2015. The practice was rated as Good for providing caring and responsive services. However, Requires Improvement for safe, effective and well-led services. Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches. We undertook an announced focused inspection on 3 May 2016 to check the provider had followed their action plan and to confirm they met the legal requirements. The practice was rated as Good for providing caring, effective, responsive and well-led services. However, remained Requires Improvement for providing safe services. Following the focused inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Mitigating risks associated with infection control by ensuring that privacy curtains within the practice were regularly laundered and that a clear record of this was kept.

We undertook this announced desk based inspection on 13 December 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and is rated as Good for providing safe services.

This report only covers our findings in relation to those requirements.

• The practice had created a clear record outlining the regular laundering of the privacy curtains and in some instances replaced existing fabric curtains with disposable.

This report should be read in conjunction with the previous reports. You can read the reports, by selecting the 'all reports' link on our website at www.cqc.org.uk

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 of Eastwick Park Medical Practice on 10 September 2015. Breaches of legal requirements were found during that inspection within the safe, effective and well-led domains. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• Ensure staff undertake training to meet their needs, including training in the safeguarding of children and vulnerable adults, the Mental Capacity Act 2005, information governance, fire safety, health and safety and infection control.
• Ensure all staff receive regular supervision and appraisal.
• Ensure criminal records checks via the Disclosure and Barring Service are undertaken for all staff who are assessed as requiring a check, such as staff who act as chaperones.
• Ensure there are formal arrangements in place for assessing and monitoring risks to staff, patients and visitors, including the management of medical emergencies and the risk of exposure to legionella bacteria.
• Ensure the security and tracking of blank prescription pads at all times.
• Ensure that records are maintained and circulated which accurately reflect the management of services provided, including records of clinical meetings, training activities, reviews of infection control audits and learning from safety incidents.

We undertook a focused inspection on 3 May 2016 to check that the provider had implemented their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

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

• Criminal records checks via the Disclosure and Barring Service were undertaken for all staff assessed as requiring a check.
• Appraisals had been undertaken for all staff.
• There was a new system in place to ensure all staff undertake training to meet their needs, staff who had not previously attended training in areas such as safeguarding and fire safety now had.
• Security and tracking of blank prescription pads was in place.
• Risk assessments had been carried out in relation to the management of medical emergencies and the risk of exposure to legionella bacteria and appropriate action had been taken to mitigate these risks.
• However, action to mitigate the risks relating to infection control had not always been fully mitigated. For example, the practice did not have a clear record of when privacy curtains in use within treatment rooms had been laundered.
• Records relating to clinical meetings, training activities and learning from safety incidents were in place.

The areas where the provider must make improvements are:

• Ensure that privacy curtains in use within treatment rooms are subject to regular laundering in line with infection control guidance and that there is a clear record of this.

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 Eastwick Park Medical Practice on 10 September 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective, and well led services. It also required improvement for providing services for older people, people with long-term conditions, families, children and young people, working 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). It was good for providing caring and 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.
• Risks to staff, patients and visitors were not always formally assessed and monitored. The practice did not have a supply of oxygen and had not assessed the risks associated with their management of medical emergencies. The practice had not assessed the risks of potential exposure to Legionella bacteria.
• The practice had not ensured the safe and secure storage and distribution of prescription pads.
• Staff had not always received training appropriate to their roles and further training needs had not always been identified and planned.
• Staff had not received regular appraisal of their performance.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice worked closely with other organisations and with local community services in planning how care was provided to ensure that they met people’s needs.
• There were systems in place for completing clinical audit cycles and we saw that audits were driving improvement in performance to improve patient outcomes.
• 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.
• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments. There were no extended hours appointments available to patients.
• The practice had a number of policies and procedures to govern activity. The practice held regular governance meetings and issues were discussed but not always clearly recorded.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

The areas where the provider must make improvements are:

• Ensure staff undertake training to meet their needs, including training in the safeguarding of children and vulnerable adults, the Mental Capacity Act 2005, information governance, fire safety, health and safety and infection control.
• Ensure all staff receive regular supervision and appraisal.
• Ensure criminal records checks via the Disclosure and Barring Service are undertaken for all staff who are assessed as requiring a check, such as staff who act as chaperones.
• Ensure there are formal arrangements in place for assessing and monitoring risks to staff, patients and visitors, including the management of medical emergencies and the risk of exposure to legionella bacteria.
• Ensure the security and tracking of blank prescription pads at all times.
• Ensure that records are maintained and circulated which accurately reflect the management of services provided, including records of clinical meetings, training activities, reviews of infection control audits and learning from safety incidents.

In addition the provider should:

• Improve signage to ensure patients are made aware of the chaperone service available.
• Improve access to extended hours appointments for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We inspected Eastwick Park Medical Practice to look at the care and treatment patients received. During our visit we observed how staff spoke to patients. We spoke with nine patients, four members of staff, the Practice Manager and two GPs over the course of the day.

We noted staff treated patients with respect. For example we saw that staff closed the doors of the consulting rooms which ensured privacy and dignity to patients. All of the patients that we spoke with told us that they felt respected by the staff at the practice. In response to this question, one patient replied “Definitely.”

Patients told us that they felt involved in their care and treatment with one person telling us “They are good at explaining things.” We noted the 2013 Department of Health Survey GP survey that of the 113 responses received, 67% of patients felt the practice was either ‘very good’ or ‘good’ at involving them in decisions about their care.

We saw that the practice had safeguarding policies that related to adults and children and there was a lead contact staff member for safeguarding at the practice.

We found that although the practice had a good recruitment policy, there were some gaps in the information required to be kept on staff files.

None of the patients that we spoke with had felt the need to complain. However they all said they would know how to make a complaint if they wished to.