Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 13 June 2017. The service was rated as requires improvement for safe and effective and good for caring, responsive and well-led. We rated the service as good overall. We issued a requirement notice in regards to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Staffing. The full comprehensive report on the 13 June 2017 inspection can be found by selecting the ‘all reports’ link for Wellington House on our website at www.cqc.org.uk.

This inspection was an announced focused follow up inspection carried out on 10 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 on 13 June 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 for providing safe and effective services.

Our key findings were as follows:

• Systems and processes such as for mandatory training and infection, prevention and control measures were in place to keep patients safe.

• The practice demonstrated they were driving quality improvement in patient outcomes.

• There was enough clinical staff to keep patients safe and deliver effective care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

The practice was previously inspected by the Care Quality Commission on 29 September 2015 and 2 August 2016 under the previous Provider. As a result of an inadequate rating the service was placed into special measures. In October 2016 Symphony Health Services agreed to assist the practice to action the changes required to ensure the service was safe, effective, caring, responsive and well-led. On 1 April 2017 Symphony Health Services became the registered provider for the location, Highbridge Medical Centre.

We carried out an announced comprehensive inspection at Highbridge Medical Centre on 13 June 2017. Overall the practice is rated as requires improvement. Following our inspection additional information and evidence was provided to demonstrate actions to ensure compliance were taken after our visit.

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 provider had clearly defined and embedded systems to minimise risks to patient safety.
• Risks in regard of patients and staff safety required an additional focus such as infection prevention control, staff mandatory training and staffing levels. However there was evidence the practice were working towards rectifying these concerns or risks in regard to patients and staff 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.
• Patients we spoke to were complimentary and spoke of a much improved service. They told us that most of the time they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear governance structure within Symphony Health Services, the provider and staff felt supported by management. However, the practice currently relied on a clinical lead to provide professional support to all clinical professionals due to vacancies and regular use of locum GPs.
• The practice proactively sought feedback from staff and patients, which it acted on.
• There was a comprehensive practice improvement plan in place and we saw evidence of new developments and changes to the practice.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvements:

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment such as provision of adequate GP appointments during core practice hours.

In addition the provider should:

• Embed clinical audits and re-audits to improve patient outcomes. And consider a process to check patients consent has been recorded appropriately.
• Address identified concerns with infection prevention and control practice.
• Embed mandatory training provision for existing staff. For example, fire safety training.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice