Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

We previously carried out an announced comprehensive inspection of Haslucks Green Medical Centre on 7 August 2017. The practice was rated as requires improvement overall, with safe rated as inadequate, effective and well-led rated as requires improvement and caring and responsive rated as good. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Haslucks Green Medical Centre on our website at www.cqc.org.uk.

This inspection was a follow up comprehensive inspection carried out on 20 February 2018 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 on 7 August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. The practice is now rated as Good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

• Care and treatment was provided in a safe way to patients.

• Effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care.

• Staff received appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

• There was an effective system in place to monitor staff training and to ensure all staff were up to date with the latest guidelines for areas such as health and safety, fire training and Infection control. .

• The immunisation status for GPs and non-clinical staff was recorded.

• All non-clinical staff who carried out chaperone duties had received a Disclosure and Barring Service (DBS) check or risk assessment.

• Staff understood their responsibilities to raise concerns, incidents and near misses and there was an effective system in place for reporting and recording significant events. We saw minutes of fortnightly clinical meetings where significant events were discussed. Regular administration team meetings took place and we saw evidence that events and incidents had been discussed with the whole team.

• The practice had a system in place to receive safety alerts and they were appropriately actioned.

• There was an effective system in place to review and action patients on high risk medicines. These patients received regular blood tests.

• The practice followed Public Health guidelines on thermometers for vaccination fridges and had appropriate systems in place

• Clinical audits demonstrated quality improvement.

• We saw evidence that complaints were discussed within both the clinical team and administration staff.

• Arrangements were in place to share information with all 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 Haslucks Green Medical Centre on 7 August 2017. Overall the practice is rated as requires improvement.

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

• The practice had a system in place to receive safety alerts, however we found the system to be ineffective and alerts were not actioned appropriately.
• The practice did not have an effective system in place for the recall of patients on high risk medicines.
• There was no effective system in place to monitor staff training and to ensure all staff were up to date with the latest guidelines for health and safety, fire training and Infection control. .
• New employees did not have infection control guidance or training relevant to their role. Staff immunisation status for GPs and non-clinical staff was not recorded and no risk assessments had been completed to mitigate risks.
• Non clinical staff carrying out chaperone duties had not the appropriate risk assessments completed in the absence of a Disclosure and Barring Service (DBS) check.
• Clinical audits did not demonstrate quality improvement.
• Staff understood their responsibilities to raise concerns, incidents and near misses and there was a system in place for reporting and recording significant events. We saw minutes of fortnightly clinical meetings where significant events were discussed. Regular meetings with the administration team had not taken place due to staff shortages and there was no evidence to confirm events and incidents had been discussed with the whole team.
• Arrangements were in place to safeguard children and vulnerable adults from abuse, and local requirements and policies were accessible to all staff.
• 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 not available for patients. We saw evidence that complaints were discussed within the clinical team, but not shared with the administration staff.
• There was a clear leadership structure and staff felt supported by management; however effective oversight to ensure governance arrangements were embedded had not been established. The practice proactively sought feedback from staff and patients, which it acted on. The GPs encouraged a culture of openness and honesty.

However there were areas of practice where the provider must make improvements:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

There were also areas of practice where the provider should make improvements:

• Consider the arrangements in place to share information with all staff to ensure there are systems in place to cascade this information to staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice