Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Garden City Medical Practice on 7 June 2016. The overall rating for the practice was requires improvement with the effective domain rated as inadequate and the safe, responsive and well led domains rated as requires improvement. The caring domain was rated as good. The practice was issued with a Warning Notice to ensure the compliance actions issued at that inspection were met. The full comprehensive report 7 June 2016 inspection can be found by selecting the ‘all reports’ link for Garden City Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 15 March 2017. 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 told us through the CQC comment cards that 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 staff and 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.
• A new practice manager had been employed since the last inspection on 7 June 2016. In partnership with the GPs they have worked hard to address the shortfalls raised at the previous inspection. They gave us an assurance that they were committed to improving the service through making the necessary changes to the leadership, management and governance of the practice.
• The recently established Patient Participation Group was organising an event to support patients with dementia and their carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 7 June 2016 we undertook a full comprehensive inspection of Garden City Medical Practice. At that inspection we found that systems and processes were not embedded sufficiently to ensure patient safety. As a result of our findings a Warning Notice was issued on 19 August 2016.

The Warning Notice advised the provider that the practice was failing to meet the required standards relating to Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

On 5 December 2016 we carried out a focused inspection of Garden City Medical Practice. We visited the practice to check if the practice had achieved compliance with the Warning Notice issued on 19 August 2016. At this inspection we found that the practice had satisfied the requirements of the Notices. Specifically we found that:

• A full time practice manager was employed at the practice.

• All staff were trained in READ coding and further training was planned.

• Regular staff meetings were held to ensure good communication.

• A recent fire drill had taken place and the fire safety equipment had been inspected.

• There was a programme of clinical audits.

• Significant events were reported and policy guidance was available.

• All staff were trained in safeguarding procedures and further training was planned.

• There was an effective system for monitoring the use of prescription sheets.

• Patients with long term health conditions were contacted when they did not attend their follow-up appointments.

• Staff training was monitored and the staff training records were up to date.

• There was an effective system in place to monitor the performance of cervical screening.

The rating awarded to the practice following our full comprehensive inspection on 7 June 2016 remains unchanged. The practice will be re-inspected in relation to their rating in the future.

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 Garden City Medical Centre on 7 June 2016. Overall the practice is rated as requires improvement.

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, significant events and near misses. Reviews and investigations of significant events had taken place, and there was evidence to demonstrate learning and changes to practice as a result. However, there were instances when no information or only minimal information was recorded about two events and any actions taken following these events.

• Staff were trained in safeguarding. However, there was some confusion amongst staff about who took responsibility for managing safeguarding alerts.

• Risks to patients were not always assessed and well managed. For example, although clinical audits were undertaken, they were not systematically completed. We saw little evidence that audits were driving improvements to patient outcomes.

• Prescriptions were not well managed. Although prescriptions were stored securely at night, a log of the blank prescription sheets numbers was not kept.

• Pre inspection data showed patient outcomes were low in some areas compared to the national average. GPs told us they had experienced some difficulties in READ coding information which had resulted in this data.

• Patients told us via the CQC comment cards they were treated with compassion, dignity and respect. Feedback from patients about the staff and their care was consistently  and strongly positive. Patients told us they were involved in their care and decisions about their treatment.

• The practice had a number of policies and procedures to govern activity.

• A record of complaints was not kept and the complaint procedure was not easily available at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We did not speak with people who used the service as part of this inspection.

We carried out this inspection to check that the provider had taken action to address the issues raised at the last inspection on 11 February 2014.

During our last inspection we found concerns relating to the arrangements in place to chaperone people during examinations and the provision of emergency equipment. Concerns were also raised about the standard of hygiene, the way medicines were managed and the staff recruitment and selection procedures. We also found some concerns relating to the quality assurance systems in place at that time.

During this inspection we found that the provider had taken action to address the issues raised and had improved the overall standard of the service.

Staff had been provided with information about their role as a chaperone and the necessary equipment was in place to deal with emergencies.

Systems were in place to ensure good standards of hygiene were maintained and infection control was promoted to ensure the safety and welfare of the people who used the service.

The recruitment and selection procedures had been reviewed and they were in the process of recruiting two new staff. They were taking up relevant pre-employment checks were appropriate.

Quality assurance systems were improved and equipment and medicines were monitored for their use and expiry dates.

During our inspection we spoke with patients and staff. Patients gave mainly positive feedback about the GPs and the staff at the practice. However, some patients said they found it difficult to access appointments. Patients’ feedback included “[My GP] is the nicest man in the world. You are never rushed”, “The girls are lovely here. All the staff are” and “Overall I am happy”.

We found that staff were available to chaperone patients but they were unaware of their role and had not been trained.

All staff had received training in cardiopulmonary resuscitation (CPR). However, there was no oxygen at the practice to use in a medical emergency. Medication was found to be stored in unlocked cupboards in consultation rooms that did not lock. The building was not secure and this medication could be accessed by members of the public or the cleaners.

The provider did not have effective systems in place to assess the risk of and to prevent, detect and control the spread of infection. The provider did not operate an effective recruitment process. There was no system in place for the supervision and appraisal of staff. There was no effective quality assurance system in place.

We reviewed the information available to us about Garden City Medical Centre on 13 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.