This practice is rated as Requires Improvement overall. (Previous inspection July 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) – Requires Improvement

This inspection was a comprehensive follow up inspection of Mayfield Medical Centre on 1 February 2018 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 in July 2017.

We have previously carried out an announced comprehensive inspection at Mayfield Medical Centre on 5 September 2016. The overall rating for the practice was requires improvement. We completed a focused inspection on 6 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations 12 (safe care and treatment) and 17 (good governance) The practice had made some improvements but for others were unable to demonstrate how they met the regulations. The provider had a repeat breach to regulation 17 and we undertook enforcement action in the form of a warning notice. The provider was given a timescale of 31 October 2017 to become compliant with the warning notice. We completed a warning notice follow up inspection on 21 November 2017 and found that the practice was compliant with the warning notice.

The full reports from all of these inspections can be found by selecting the ‘all reports’ link for Mayfield Medical Centre on our website at www.cqc.org.uk

Overall the practice remains rated as requires improvement.

Our key findings were as follows:

• Improvements had been made to systems and processes around monitoring health and safety risk assessments. All actions from identified from a fire risk assessment had been completed. The practice had completed a further health and safety risk assessment and actioned any risks identified from this.
• All staff had received training suitable for their role including, fire safety, safeguarding and infection control.
• Improvements had been made to infection control policies which had been reviewed and embedded into practice. This included, all staff having received training and audits being completed in line with timescales set out in the practice policy.
• The practice demonstrated how they learned from significant events and complaints.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines. However, there was no formal system in place to record that all staff had received or read the relevant guidance.
• Staff treated patients with kindness and respect. The practice had identified ways to enhance patient privacy in the waiting area.
• Approximately 30% of the practices population were either Nepalese or had Nepali heritage. As such the practice offered a range of clinics and assessments in Nepalese. This included the local Desmond group for diabetic care and memory assessments.
• Mayfield Medical Centre hosted a weekly youth counselling service to improve access to these services for young people in the local area.
• Policies had been reviewed and documented with version control measures.
• Patient satisfaction, as obtained from the national GP patient survey data, had declined since the previous inspection. This included for access to the service. There was no action plan in place to address this.
• Quality and Outcome Framework data was comparable to or below local and national averages. Although exception reporting levels for mental health indicators had improved since the previous inspection.

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

The provider should:

• Review arrangements with external companies contracted to conduct specialist health and safety risk assessments so that documents are stored at the practice.
• Review the processes upon receipt of safety alerts before disseminating to all staff.
• Review the patient survey results to improve the patient experience at the practice.
• Review processes for increasing the outcomes for patients with long term conditions.

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 focussed inspection at Mayfield Medical Centre on 21 November 2017 to follow up on one warning notice.

The practice was previously inspected on 5 September 2016 where we carried out a full comprehensive inspection and we rated the practice as requires improvement overall. We completed a further announced focused inspection on 6 July 2017 to follow up on the safe and well-led key questions. We rated the practice as requires improvement for safe and inadequate for well-led. The practice is rated as requires improvement overall and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report. As a result of the inspection a warning notice was served. The timescale given to comply with the warning notice was 20 October 2017.

The warning notices served related to regulation 17 Health and Social Care Act as a result of the following issues:

• Risk assessments relating to the health, safety and welfare of people using services were completed but actions identified were not completed within the timescales set by the risk assessments.

• The practice did not ensure all leaders had the necessary experience, knowledge, capacity and capability to lead effectively. There was no registered manager at the practice.

• Governance arrangements and risk management were not fully embedded such as not completing bi-monthly infection control spot checks as per the practices policy.

• The registered GP partners did not have oversight of the actions required from risk assessments or the timescales these needed to be completed in.

• Not all staff had been trained in areas required to undertake their role, this included infection control and fire safety.

• The practice had not met their deadlines for actions to provide further training to staff in respect of complaints handling.

At our inspection on 21 November 2017 we found the provider had complied with the warning notice in relation to regulation 17.

Our key findings were:

There were now more systems and processes in place; for example

• Risk assessments for areas such as Legionella and fire safety had been carried out, and there was a system to monitor and act on the findings of the assessments. All areas with identified actions had now been completed.

• All staff had received training in fire safety and additional training for the allocated fire marshals. A full fire drill had been completed by the practice with the next one planned.

• Infection control audits were conducted every other month as a spot check in line with the practices policy. Findings were discussed with the GP partners.

• All staff had received infection control training.

• The majority of administration staff had completed customer care training with a plan in place for those who had yet to do so.

• Practice policies and procedures were now appropriately reviewed and updated to ensure their content was current and relevant.

• There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

• All four GP partners had applied to become registered managers and have enrolled on leadership courses.

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 Mayfield Medical Centre on 5 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Mayfield Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 July 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 5 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as requires improvement.

Our key findings were as follows:

• The practice had undertaken a fire risk assessment and implemented the majority of the required actions. However, many of the actions marked for urgent attention had not been completed within their set timeframes. There was also no record of fire drills.
• No staff had completed fire safety awareness training but this was scheduled to be completed by the end of July 2017. No fire marshal had been allocated for the practice.
• There were shortfalls in infection prevention control. The practices infection control policy was not fully adhered to as staff had not received training in this area and there was no infection control audit. Bi-monthly spot checks had not been completed as per the infection control policy. The practice had created a waste management policy.
• The practice had improved the storage of emergency medicines.
• All patient group directions had been signed by the nursing staff and an authorising member of staff in order that the nurses had the correct legal authority to administer the vaccines.
• The practice had added an alert to patient’s records to identify carers. The practice had only identified 1% of its patient population as carers.
• Policies had been reviewed and updated however, not all were adhered to by the practice.
• The chaperone policy had been updated to clearly reflect processes at the practice.
• Staff had still not received customer care training despite being recognised by the practice as needed following ongoing complaints around this theme.
• The practice had continued to work with the local clinical commissioning group to enhance patient services for example to set up a mental health café.

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

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

Continue to review arrangements for identifying carers.

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 Mayfield Medical Centre on 5 September 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 however, improvements were needed to how these were managed such as for training of staff, environmental action and policies and procedures needed updating.
• 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.
• Patients 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 and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure systems and processes are identified, implemented and reviewed for the management of infection control and fire safety.

• Ensure all practice policies and procedures are regularly reviewed, updated and adhered to for example, the business continuity plan, patient group directions and chaperone policy.

• Ensure all staff have received appropriate training to carry out their role such as for infection control and chaperoning.

The areas where the provider should make improvement are:

• Review arrangements for storage of emergency medicines so that they are easily accessible.
• Review arrangements for identifying carers to include a flag on the practice’s record system.
• Review the business continuity plan to include emergency contact numbers for staff.
• The practice should improve access to appointments for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating 02/2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Mayfield Medical Centre on 21 November 2018. This was as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

Continue to make improvements in Quality Outcome Framework results in the areas af Diabetes care and Child Immunisation.

Continue to improve patient access to booking appointments.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.