This practice is rated as requires improvement overall.

(At the previous inspection in February 2015 the practice was rated as good overall but the safe domain was rated as requires improvement).

The key questions are rated as:

Are services safe? - Requires improvement

Are services effective? - Requires improvement

Are services caring? - Good

Are services responsive? - Requires improvement

Are services well-led? - Good

We carried out an announced comprehensive inspection at Gladstone Medical Centre on 3 October 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Gladstone Medical Centre was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• Risks to patients were assessed and well managed in some areas, with the exception of those relating to the level of exception reporting and management of blank prescription forms.
• The practice’s uptake of the national screening programme for breast and bowel cancer screening and childhood immunisations rates were below the national averages.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. 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.
• Some staff had not received all the required training that was relevant to their role.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Results from the August 2018 annual national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was significantly below the local and national averages.
• The practice was aware of and complied with the requirements of the Duty of Candour.
• 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 improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review and ensure all staff have received training relevant to their role including sepsis awareness training.
• Implement a system to ensure the record keeping of a defibrillator checks.
• Review staff feedback in relation to non-clinical staffing levels.

• Continue to promote the benefits of the national screening programme and monitor the practice’s uptake for breast and bowel cancer screening.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gladstone Medical Centre on 12 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for five out of the six population groups we report on. It required improvement for providing safe services and for providing care to people whose circumstances may make them vulnerable.

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.
• Patients’ needs were assessed and care was planned and delivered following best practice 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.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Improve the storage arrangements for vaccines and other medicines to ensure these comply with best practice guidelines.
• Carry out an infection control audit to monitor for any risks to staff or patient safety.

In addition the provider should:

• Review staff knowledge of the Deprivation of Liberty Safeguards (DoLS) legislation as it applies to general practice because it may be relevant to work carried out at a local care home.
• Review and update the business continuity plan to ensure that adequate emergency arrangements are in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice