Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Enki Medical Practice on 11 February 2016. The overall rating for the practice was requires improvement with requires improvement ratings in safe and well-led services. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Enki Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection carried out on 25 October 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 11 February 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection. Overall, the practice is now rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 leadership structure and staff felt supported by management. The practice proactively sought feedback from 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.
• The practice had tailored their services to meet the needs of its patient population.
• The practice had 140 substance misuse patients on their register, staff we spoke with were passionate about caring for this patient group.

The areas where the provider should make improvement are:

• Consider how patients are informed regarding the availability of weekend appointments.

• Ensure that lines of accountability are clear to ensure that policies are well governed and fully embedded at the practice.

• Consider formalising the clinical supervision arrangements for the nursing team.

• Continue to explore and work on ways to improve telephone access.

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 11 February 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Some risks to patients were assessed and managed, with the exception of some relating to recruitment checks, management of medicines and medical emergencies as well as infection prevention and control.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• 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 could get an appointment when needed but found the telephone appointment system confusing.
• 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 areas where the provider must make improvement are:

• Ensure appropriate emergency medicines are available.

• Improve infection prevention and control (IPC) measure to stop the risk and spread of infections.

• Systems or processes must be operated effectively to ensure there are no gaps in recruitment and staffing processes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The visit to the practice was announced. This was to ensure we had the opportunity to speak to the doctors and staff working at the practice. We visited the surgery to establish that the needs of patients using the service were being met. During the inspection process we spoke with seven patients, five staff members, two doctors and members of the management team.

In order to target our inspections effectively we gather information about services. This may include information from NHS England, patients or staff. Before an inspection we reviewed the information we had. The information directed us to review cleanliness and infection control and the systems in place to support staff.

Below is a summary of our findings based on our observations, speaking with patients and staff.

Is the service caring?

The patients we spoke with were happy with the care, support and treatment they received. They told us they were treated respectfully. We were told that doctors and nurses took the time to listen to the patients.

Is the service responsive?

We found the staff training records difficult to follow. We were unable to confirm what the mandatory training requirements were for each role and what training had been completed. There was no set schedule in place to ensure staff training remained up to date.

Is the service effective?

The patients we spoke with told us that they were supported with long term conditions such as diabetes. We saw that patients received regular reviews of their condition and where appropriate had been referred to community care services.

Is the service well led?

Systems were in place to review complaints and significant events happening in the practice. Regular meetings were in place to ensure all staff were kept informed of development and improvement opportunities.

Is the service safe?

We saw that an infection control policy was in place and available to staff. There was also an infection control audit tool which had been completed on a monthly basis. The audit tool enabled the practice to identify areas which required improvement and attention.