Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Merridale Medical Centre – RP Tew on 14 July 2016. Overall the practice is 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.

• 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.

• 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 did not always find it easy to understand the appointments system or make an appointment with a named GP or that there was continuity of care, with urgent appointments available the same day. However, the practice was pro-active in improving the availability of appointments for patients and had successfully recruited additional clinicians to improve access to appointments.

• The practice employed an admissions avoidance practitioner who carried out visits to patients who resided in care and nursing home patients and housebound patients and acted as a care coordinator.

• Performance for mental health related indicators was 100% which was better than the national average of 93%. This included an exception reporting rate of 6% which was better than the national average of 11%.

• The practice employed a mental health practitioner and provided 30 minute pre-bookable appointments and 15 minute crisis appointments which were bookable on the day. Patients were able to book appointments directly with the mental health practitioner. Home visits were also provided and carried out care plan reviews in the community for patients who suffered with dementia.

• 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 should make improvement are:

• Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it.

• Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including in respect of satisfaction on access to appointments and use of the appointments system and also in respect of consultations with GPs and nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This visit was a follow up inspection to check compliance from our last inspection in October 2013. On the day of the inspection we spoke with two members of staff the practice manager and the reception manager. We found the service had made improvements to meet the standards.

There were formal procedures for staff to access translation and interpretation services. The provider promoted and recognised the patient’s diversity and values. Patients understood the care, treatment and support choices available to them.

We found the practice had improved their systems for protecting patients from abuse. Appropriate guidance was available for staff to follow if abuse was suspected.

We found patient’s comments and complaints were listened to and acted on effectively. The provider had systems in place to analysis complaints to ensure they recognised any themes and any learning from complaints. We found the practice provided patients with clear information about the complaint systems. We found the Patients Participation Group (PPG) had recently been consulted and assisted the provider when considering and responding to complaints.

We spoke with five patients during our inspection. Everyone we spoke with was satisfied with the service they received. Comments patients made included: "No bad comments definitely," "We're quite satisfied with the practice" and "It's a good service." Despite expressing their overall satisfaction, three of the patients we spoke with told us about improvements they thought could be made. These included seeing the health professional of their choice, availability of appointments and access to interpretation and translation services.

We found the practice had no formal procedures for staff to access translation and interpretation services. This meant staff were using different methods to access information in patients’ first languages.

There were systems in place to ensure patients had access to health advice and treatment from appropriate professionals. Some patients did not understand the roles of different health professionals because the practice had not provided enough clear information.

We found the practice needed to improve their systems for protecting people from abuse. This was particularly lacking in relation to vulnerable adults.

We found there was a clear complaints policy and procedure. Most patients were aware of this. Managers were aware they needed to improve their analysis of complaints to ensure they recognised any themes and any learning from complaints.