Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Erdington GP Health and Wellbeing Walk in Centre on 19 January 2017. The overall rating for the practice was requires improvement. Breaches were identified in relation to regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Erdington GP Health and Wellbeing Walk in Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 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. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection on 19 January 2017.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had made significant progress in relation to the concerns raised at our previous inspection in January 2017.
• The practice had reviewed its systems to manage risks and keep patients safe. For example, improvements had been made to the monitoring of the premises, staff recruitment and prescription safety.
• Systems had been put in place to monitor the quality of services, including GP consultations and a rolling programme of clinical audit had been introduced.
• Systems had been put in place to monitor staff compliance with the provider’s core training requirement.
• Policies and procedures previously containing out of date information had been reviewed and updated.
• Governance arrangements had been strengthened with clearer leadership and input from senior medical staff.

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 Erdington GP Health and Wellbeing Walk in Centre on 19 January 2017. Overall the service is rated as requires improvement.

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

• There were effective systems in place for recording, reporting and learning from significant events.
• We found in some areas there were effective systems to keep patients safe including safeguarding patients from abuse, safe prescribing and ensuring sufficient staff on duty. However, we also found areas of weakness for example, in relation to recruitment checks.
• Risks to patients were not always effectively managed and we found gaps in the management and monitoring of risks relating to the premises.
• Patients’ care needs were assessed and delivered in a timely way according to need.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had appropriate skills, knowledge and experience to deliver effective care and treatment.
• There was a lack of systems in place to monitor the quality of services provided. Although consultations with nursing staff were audited there were no systems in place for GP performance. There was also little evidence of quality improvement activity for example through clinical audit.
• Patients were positive about the service received and said they were treated with dignity and respect and were satisfied with their involvement in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. There was evidence of learning from complaints which supported improvements to the quality of care.
• The service was accessible to all patients and helped provide an alternative to attendances at hospital.
• The provider had good facilities and was well equipped to treat patients and meet their needs.
• There was clear leadership in the day to day management of the service and staff felt supported by the Clinical Nurse Manager. Regular staff meetings were held to ensure important information was shared. However, there was a lack of clear senior medical support in the governance arrangements.
• The provider proactively 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.

• The provider did not currently have a registered manager with CQC. Relevant applications had been started but not completed.

The areas where the provider must make improvement are:

• Ensure effective systems are place to assess, monitor and mitigate risks to the health, safety and welfare of service users and others who may be a risk. This would include the monitoring of the cleaning of the premises, the follow up of actions relating to fire and legionella risk assessments, for ensuring COSHH safety information is accessible when needed and for monitoring staff training and recruitment information.
• Ensure effective systems are in place to assess, monitor and improve the quality and safety of the services.

The areas where the provider should make improvement are:

• Review business continuity plan to identify the benefits of adding relevant staff contact information.
• Maintain accurate records of prescription use.
• Ensure locum pack is kept up to date.
• Review arrangements for senior medical support for the service including contingency arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Badger Midlands Medical Limited provides services in a GP-led walk-in centre in Erdington, Birmingham. The service includes an ‘out-of-hours’ primary medical service, which operates between 6.30pm and 8pm on weekdays and from 8am to 8pm at the weekend and on bank holidays.

During our inspection we spoke with five patients who were using the service, as well as the chair of the patient user group and six clinical and administrative staff. All patients told us that they were happy with the service they received.

There were systems in place to ensure the safety of patients; these included learning from incidents and safeguarding patients that may be at risk of harm. The service was provided in a clean and hygienic environment.

We were concerned that the provider did not have robust arrangements to recruit staff. Recruitment checks were inconsistent and did not provide adequate assurance that patients would be protected from the risks of unsuitable staff.

We found the service was effective in meeting a wide range of needs. There were processes to ensure that those with urgent needs were seen as a priority and staff had access to equipment and guidance to respond.

The service was responsive to the needs of patients. Information collected about the patient through triage arrangements supported clinical decisions.

Patients told us they received a caring service and that they were involved in discussions about their health care. We observed staff treating patients with sensitivity.

The provider actively asked patients for their views and feedback was very positive. Both staff and patients were actively involved and able to share their views in meetings with senior staff. Staff described an open culture in which incidents, comments and complaints were reported, investigated and responded to.

However, staff were not always well supported. Some did not receive induction training before starting to work for the service to ensure they were familiar with the systems and processes in place. Staff were not always given formal opportunities to discuss their performance, personal development needs and any other issues relating to their role.

The practice manager informed us that the registered manager for the service was due to leave the service in April 2014. Both the registered manager and the provider must ensure that they submit relevant forms to CQC in a timely manner, to ensure that the manager who no longer works for the service is removed from registration.