We carried out an announced comprehensive inspection at Jubilee Gardens Medical Centre on 28 February 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated the practice as requires improvement overall. Our previous inspection in September 2017 rated the practice as requires Improvement.

We have rated all population groups as good and requires improvement due to concerns with patient satisfaction with consultations and appointments access.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way. However, some patients reported concerns with accessing appointments at the practice.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Develop a sepsis toolkit and provide a safety net leaflet for patients to provide more information on identifying signs of sepsis.
• Review the storing of blank prescriptions that are kept by clinicians off site.
• Strengthen the policy of following up patients on high risk medicines; who are receiving care in a variety of settings.
• Review how to identify and support young carers.
• Continue to improve patient satisfaction with consultations and appointments access.
• Review how complaints are dealt with, discussed and shared with the team where appropriate.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jubilee Gardens Medical Centre on on 27 August 2015.The overall rating for the practice was good; however the practice was rated as requires improvement for the safe domain. The full comprehensive report can be found by selecting the Jubilee Gardens Medical Centre ‘all reports’ link for on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 26 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 27 August 2015. This report covers our findings in relation to those requirements and additional improvements made since our last inspection. However the national GP survey results for caring and responsive indicators had got worse since our previous inspection in August 2015. We have therefore judged that the practice is now rated as require improvement.

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 practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff was aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• The practice received low scores for several areas relating to patient’s satisfaction with how they could access care and treatment from the national GP patient survey July 2017.

• 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 majority of patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

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

The provider should:

• Review and improve the process of identifying carers.

• Continue to address and improve patient satisfaction in areas identified as below average in the July 2017 GP patient survey.

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 Jubilee Gardens Medical Centre on 27 August 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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. Lessons were shared to make sure action was taken to improve safety in the practice.
• Risks to patients were assessed and well managed. The practice had arranged an external Health and Safety Assessment that confirmed health and safety risks were addressed.
• Staff had received training in basic life support and had access to appropriate equipment to manage medical emergencies. However the storage arrangements for emergency equipment and medicines along with an unmonitored patient waiting area, potentially limited timely response if resuscitation was required.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They told us staff were helpful, caring and pleasant.
• 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 with members of staff in key leadership roles. Staff were aware of their roles and responsibilities and felt supported by the management team.

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

Importantly the provider must:

• Review the arrangements in place for dealing with medical emergencies, including the storage of emergency equipment and medicines and unmonitored patient waiting area.
• Ensure that spill kits are available in the event of accidental mercury spillage from blood pressure monitors still in use at the practice.

The provider should:

• Ensure clinical staff undertakes Mental Capacity Act (2005) awareness training.
• Conduct independent clinical audits in addition to CCG audit requirements.
• Ensure there is a system in place for monitoring distribution of prescription pads.
• Review the storage of paper medical records to ensure compliance with information governance requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with eight people using the service and seven staff including the practice manager, three GP's, the chair of the Patient Participation Group, reception and administration staff.

People told us they were treated with respect and given the information they needed to make decisions about their care and treatment. One person said "the doctor is very good, she always explains things to me.”

People told us they were happy with the care and treatment they received. One person told us "I can usually get an appointment with the doctor or I can ask for a phone consultation and she will ring me back.” Another person said “when I’ve needed a referral to the hospital it’s always done straight away.”

People were protected from the risk of abuse. The practice had procedures in place for safeguarding children and staff followed them. The procedures for safeguarding adults using the service were not as developed and the Practice Manager told us she would address this following our inspection.

Staff had received adequate support and training to meet the needs of people using the service, including induction training for new staff, training to deal with medical emergencies and training specific to their role. Appraisals had been completed to assess staff performance and identify any development needs.

Effective systems were in place to monitor the quality of service provided including satisfaction surveys, audits and risk assessments. The results of surveys and audits had been analysed and action taken to make improvements to the service where necessary.