Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hedgemans Medical Centre Practice on 4 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Hedgemans Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 September 2017 to confirm 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 4 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At the previous inspection we rated the practice as requires improvements for caring and being well-led as the registered person did not always ensure the privacy of patients. They also failed to implement actions identified in the health and safety risk assessment to improve the quality and safety of services in the recommended time.

At this inspection we found improvements had been made and the practice is now rated as good overall and the provision of caring and well-led services are now also rated good.

Our key findings were as follows:

• The practice now had systems in place to monitor repeat prescriptions, however this needed improvement. We found uncollected prescriptions were not dealt with according to the practice’s repeat prescribing policy. Following the inspection, the practice provided us with a copy of the “prescription destruction log” as well as the uncollected prescription policy.

• We reviewed two different risk assessments to check the provider was implementing identified actions. All actions highlighted in both audits had been completed on or before the recommended time.

• We saw certificates which confirmed staff had received training in information governance.

• Verbal complaints were now investigated and followed up with patients. We reviewed minutes of staff meeting and found complaints were discussed and shared with all staff.

• A hearing loop had been installed for those who had difficulty hearing.

• Actions were taken to improve patient confidentiality.

• There was now a notice in the reception area which informed patients of the translation and interpreting service.

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

The provider should:

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Continue to maintain records relating to uncollected repeat prescriptions.

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 Hedgemans Medical Centre on 4 August 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.
• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks.

• Data showed patient outcomes were comparable to the national average.
• Although some audits had been carried out, we did not see evidence of a programme of audits to improve patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt their confidentiality was maintained as conversations could be heard from the consultation room as well as the reception desk.
• The practice did have disabled access but did not have accessible facilities or baby changing facilities. There was no hearing loop for people heard of hearing.
• Information about services and how to complain was available and easy to understand. However, we did not see evidence of improvements that were made to the quality of care as a result of complaints and concerns and the practice could not evidence that learning was shared with staff.
• The practice had a number of policies and procedures to govern activity.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• The practice must ensure that patient confidentiality is protected and patients can speak privately in consultations.
• Review the systems for managing complaints to include a review and documentation of both verbal and written feedback. A record of learning outcomes to be shared with staff and patients in order to drive improvements in the services provided.

• Implement a programme of quality improvement including audits to show improvements in patient outcomes.

In addition the provider should:

• Ensure systems are in place to monitor repeat prescriptions.
• Ensure improvements identified in risk assessments are actioned and recorded within the set period to improve services.
• Ensure all staff receive and complete required training to carry out their roles effectively, including information governance.
• Review systems to identify carers in the practice to ensure they receive appropriate care and support. Consider ways to support patients who are hard of hearing.
• Display notices in the reception areas informing patients that translation services are available.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice