Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 11 December 2015 at Lady Margaret Road Medical Centre. At that inspection the practice was rated good overall. However we rated the safety of the service as requires improvement. This was because staff members were acting as chaperones without having had training and also because the practice was not equipped with a defibrillator for use in an emergency and could not show it had effectively assessed this risk. The full comprehensive report of the 11 December 2015 inspection can be found by selecting the ‘all reports’ link for Lady Margaret Road Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review and commenced on 19 December 2016 to check that the practice had followed their plan to address the findings identified in our previous inspection on 11 December 2015. This report covers our findings in relation to those requirements and also outlines additional improvements made since our previous inspection.

Overall the practice remains rated as good. Following this inspection, we revised the practice’s rating for safe services and the practice’s rating for the care of people of working age to good.

Our key findings were as follows:

• Administrative staff members who acted as chaperones had completed formal training on how to carry out the role effectively.
• The practice had purchased a defibrillator with pads since our previous inspection. The practice also provided evidence of staff training and the routine monitoring checks it was carrying out on this equipment.
• We noted improvements to the practice’s cervical screening uptake rate since our previous inspection.
• The practice had introduced a telephone reminder system to encourage patients to attend for bowel screening which had been recognised through the clinical commissioning group’s local improvement scheme 2015/16.
• The practice had identified 46 patients who were carers, that is, 1.5% of the practice list. The practice had also designated one of the staff members as a ‘carer’s champion’ and had an agreement with the local carers centre to refer carers there if they needed advice or additional support.

However, there remained one area of practice where the provider needs to make improvements. The provider should:

• Continue to focus on ways to improve patient satisfaction. In our previous inspection we reported on the national GP patient survey results for the practice. For example, at that time the most recent survey results showed that 55% of patients said the last GP they saw was good at involving them in decisions about their care (compared to the clinical commissioning group average of 74%). The current survey results show little change as yet with 57% of practice patients responding positively to this question.

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 Lady Margaret Road Medical Centre on 11 December 2015. Overall the practice is rated as good.

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

• There was an open approach to safety and an effective system in place for reporting and recording significant events. The provider complied with the requirements of the duty of candour.
• Most risks to patients were assessed and well managed. However some practice staff acting as chaperones had not received training and were unclear about aspects of the role.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However the practice consistently scored below average on the national GP patient survey for these aspects of care.
• 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.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care. Urgent appointments were available the same day. The practice opened on weekends on a rota basis to Ealing patients who required access primary care. 
• The practice developed care plans for patients with complex needs and reviewed cases at locality multidisciplinary meetings.
• The practice participated in local initiatives to improve access to care, for example providing anticoagulation clinics, phlebotomy, ECG testing, insulin initiation to patients in the locality.
• 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 areas where the provider must make improvement are:

• The practice must ensure that all staff undertaking chaperone duties have training on the purpose of the role and how to carry it out.
• The practice should record its risk assessment showing that a defibrillator is not required.

The areas where the provider should make improvement are:

• The practice should maintain a stock of emergency medicines that meets with current recommendations for general practice.
• The practice should continue to review ways to improve cervical and bowel screening uptake and coverage rates.
• The practice should review the unusually low prevalence of chronic obstructive pulmonary disease within its population.
• The practice should continue to review ways to improve patient satisfaction, for example, with the timeliness of appointments and involvement in decision making.
• The practice should review it's systems to identify carers and to provide them with support.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

During our inspection we spoke with three people using the service, the practice manager, two GP's, the receptionist and secretary. We viewed two medical records.

People told us the service they received overall was good. They said that staff were friendly and polite and care and treatment was provided with respect and consideration. People received care and support that met their assessed needs.

We saw that people were involved in making decisions about their care and treatment and where required appropriate referrals were made to the relevant hospital.

Feedback obtained from people using the service had led to some improvements being made, such as appointments and extended surgery hours.

Systems were in place for safeguarding children and adults.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People told us they could speak with staff if they had any concerns or worries. The provider had in place an effective complaints management system.