This practice is rated as Good overall. (Previous rating May 2017 – Good)

The key questions at this inspection 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 Enderby Medical Centre on 8th August 2018 as part of our inspection programme to ensure the improvements we had seen in May 2017 had been maintained. The practice was inspected in May 2016 and found to be inadequate in safe and well led and placed in special measures. When we inspected in May 2017 we found that it was good overall.

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 was organised and efficient with effective governance processes and was forward thinking on delivering care services in the future.
• The practice had a culture of raising awareness of local services available to patients and organised a health fair to promote all health care services in the area. Patients were able to have blood pressure readings, sign up for screening procedures or find out more information about local services available to them. The practice management  had also developed a locality hub with four other practices and other agencies such as Blaby District Council, which held monthly meetings to promote awareness of the locality and offer support where required.

We saw one area of outstanding practice:

• The practice had purchased a machine to provide testing for inflammatory markers which are present when a patient is infected. This could be done at the practice to identify patients who would benefit from antibiotics from a small blood sample. The practice published a study on the effectiveness of this showing it reduced antibiotic prescribing and hospital admissions for respiratory tract infections.

The areas where the provider should make improvements are:

• Review the buddy system for receiving test results and correspondence is effective.
• Review the process for summarising patient records to enable them to be completed in a timely manner.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Enderby Medical Centre on 13 January 2017. The purpose of this inspection was to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings at our inspection in May 2016 when we found the practice to be inadequate overall. Overall the practice is now rated as good.

At this most recent inspection we found that extensive improvements had been made and specifically, the ratings for providing a safe and well led service had improved from inadequate to good and the rating for providing an effective service had improved from requires imiprovement to good. The ratings for providing a caring and responsive service remained good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• 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.
• Patients said they found it easy 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 and strong leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• Data showed patient outcomes were higher than the national average.
• We saw evidence that audits were driving improvements to patient outcomes.

The areas where the provider should make improvements are:

• Ensure Patient Group Directions (PGDs) are signed appropriately.

• Ensure vaccinations are stored appropriately.

• .Ensure staff are up to date with all training.

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 this practice on 11 May 2016. Breaches of legal requirements were found in relation to governance arrangements within the practice. We issued the practice with two warning notices requiring them to achieve compliance with the regulations set out in those warning notices by 1 July 2016. We undertook this focused inspection on 23 September 2016 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.

At this inspection we found that the requirements of the two warning notices had been met. Our key findings across the areas we inspected for this focused inspection were as follows:

• The practice had made considerable improvements since our last inspection. We saw there was now an effective system in place for reporting, recording and acting on significant events.

• Complaints were logged but the system required further development to evidence that complaints were fully investigated, learning identified and actions implemented.

• There was now an effective system for disseminating and acting on safety alerts.

• The practice had reviewed the arrangements for triaging and seeing patients with minor illness. The necessary training had been undertaken to provide this safely.

• There were arrangements in place for assessing and monitoring risks and the quality of the service provision.

• Policies were available which had been reviewed and gave staff guidance to carry out their roles in a safe and effective manner and reflected the requirements of the practice.

• A comprehensive system had been introduced to ensure national guidance was disseminated, discussed and implemented.

• Blank prescriptions were handled in accordance with national guidance.

• Some Patient Group Directions (PGDs) were not signed appropriately.

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

The areas where the provider should make improvements are:

• Ensure Patient Group Directives are appropriately signed.

• Ensure complaints are fully investigated, learning identified and actions implemented.

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 Enderby Medical Centre on 11 May 2016. Overall the practice is rated as inadequate.

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

• Staff had a limited understanding regarding their responsibilities and the process to report incidents and near misses. Reviews and investigations were not thorough.
• Not all risks to patients were assessed and well managed, for example, those relating to recruitment checks, control of substances hazardous to health and emergency equipment.
• Data showed patient outcomes were higher than the national average.
• We saw evidence that audits were driving improvements to 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had a number of policies and procedures to govern activity, but some of these required updating.

• The practice had a proactive patient participation group and had sought feedback from patients.

The areas where the provider must make improvements are:

• Implement a robust system and processes for reporting, recording, acting on and monitoring significant events, incidents and complaints.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Implement a robust system for dealing with safety alerts.

• Ensure there is a robust system in place to ensure that patients are safeguarded from abuse and improper treatment.

• Ensure formal governance arrangements are in place, including systems for assessing and monitoring risks and the quality of the service provision.

• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice, including the dissemination of national guidance.

• Ensure blank prescriptions are handled in accordance with national guidance.

• Ensure there is a system in place to provide staff with the necessary training and competence to provide care or treatment safely and that they are supported by means of annual appraisals.

• Ensure Patient Group Directions (PGDs) are signed by the appropriate staff.

In addition the provider should:

• Embed a formalised process for the recording of minutes of meetings.

• Ensure patients’ privacy and dignity is protected.

• Have in place a complete system to ensure that infection control is effective.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We did not speak to people on this inspection.

We found that the provider was now compliant around safeguarding, requirements relating to workers and quality assurance.

The five patients we interviewed told us doctors listened to them and respected their views and decisions about their own health. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. A patient commented: "They are brilliant I have been referred to the pharmacist to help me stop smoking." Some patients told us appointments could be made immediately or up to four weeks in advance. This meant that patients were able to get care and treatment when they needed it and when it was convenient for them. Two patients told us they had been referred to see specialists and felt doctors had assessed them properly. This meant that systems were in place for patients to be assessed and treated by specialists. All of the patients we spoke with told us they felt safe when they visited the practice or when they had a home visit. We found a positive open culture at this service. Patients told us they had confidence in the staff and how they spoke with them. We found the practice was non compliant around safeguarding, requirements relating to workers and quality assurance.