Letter from the Chief Inspector of General Practice

We first inspected Iver Medical Centre in April 2015. At that time we rated the practice as requires improvement. Specifically we found the practice had breached the regulation related to good governance of services by not operating consistent systems of risk assessment or responding to patient feedback.

This inspection was carried out on 26 May 2016 and was a comprehensive inspection because we had not returned to the practice within six months. We found the practice had addressed the issues that gave rise to the breach of regulation that occurred in 2015 and had made significant progress. 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 an effective system in place for reporting and recording significant events. The practice had made improvements to ensure learning from significant events was shared with the practice team in a consistent manner.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. 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 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 and complied with the requirements of the duty of candour.
• Patients reported an improvement in their ability to obtain appointments within a reasonable timescale and the practice had amended their appointment system to ensure urgent appointments were available the same day.
• The practice had formed a patient participation group (PPG) (a PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care). Members of the PPG told us that the practice was open in working with them and encouraging feedback. Both the practice and PPG told us they were on a continuing path of improvement.

We saw an area of outstanding practice:

• The practice had initiated a visiting NHS physiotherapy clinic specifically for patients aged over 75 years. The clinic helped these patients to maintain mobility and independence and reduced the number of visits to hospital clinics. Twenty six patients had been referred to this service in four months and they had received between one and five treatments after initial assessment.

The areas where the provider should make improvement are:

• Review systems to monitor and review telephone calls to the practice to ensure patients have appropriate access to booking appointments.

• Continue to review appointment availability based on patient feedback.

• Ensure chaperoning during intimate examinations is only undertaken by staff who understand the nature of the examination.

• Review the knowledge and understanding of staff carrying out chaperone duties based on the nature of the examination being supported.

• Review how hospital discharges are managed and reported to ensure patient safety.

• Ensure the improvements in security of blank prescriptions are sustained.

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 Iver Medical Centre on 7 April 2015. Overall the practice is rated as requires improvement.

We found the practice to be good for providing effective and caring services. The practice requires improvement in the provision of safe and responsive services and for being well-led. It also requires improvement for all of the six population groups we assessed.

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.
• Significant events and complaints were not always fully investigated and did not always lead to changes in protocol and practice.
• Communication channels and regular meetings were available to all staff which enabled them to be involved the running of the practice.
• Risks to patients were assessed and well managed including infection control, premises maintenance, equipment checks and emergency procedures.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• There was a system for following up test results but this could have been improved by using the electronic patient record system.
• The practice was involved in several pilots and enhanced services to improve patient care and welfare.
• Staff training was identified, monitored and undertaken to ensure staff could fulfil their roles safely and effectively.
• Patient feedback showed 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.
• Patients said they sometimes found it difficult to make an appointment and getting through on the phone could be hard. The practice operated a system of triage, to assess patient need for an appointment. However, we found some patients were referred to walk-in centres even when face-to-face appointments at the practice were still available.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There had a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• There had been changes to the leadership structure. An external consultant service had been used to review management and clinical monitoring of patients’ care.

We found one area of outstanding practice:

• Screening of patients considered at risk of dementia had identified more diagnoses of patients with early forms of dementia than any other practice in the Clinical Commissioning Group (CCG).

There were areas of practice where the provider must make improvements.

• Investigate, respond, review and where necessary improve the service based on complaints and significant events.
• Implement a robust programme of clinical audit

• Ensure that patients who need to see a GP at the practice are able to do so and not referred to walk-in centres as a means of accessing care.
• Review and act on patient feedback regarding the appointment system to ensure it meets the needs of the patient population to the best of the practice’s ability

Additionally the provider should :

• Complete fire risk assessment and any required actions
• Ensure clinical waste is stored securely
• Review the process for providing flu vaccinations to increase uptake among at risk groups
• Develop a functioning and representative Patient Participation Group (PPG)

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice