This practice is rated as requires improvement overall. (Previous inspection May 2016– Good)

The key questions are rated as:

Are services safe? – requires improvement

Are services effective? – requires improvement

Are services caring? – Good

Are services responsive? – Good

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

We carried out an announced comprehensive inspection at Monarch Medical Centre

on 20 March 2018 as part of our inspection programme.

At this inspection we found:

• Safeguarding policies and procedures were in place. However, we found the procedures needed to be updated further to reflect current guidelines.
• Overall, the practice had systems to manage risk so that safety incidents were less likely to happen. When incidents happened, the practice learned from them and improved their processes. However, we found that some improvements were needed to these systems as clinical discussions held by GPs were not routinely recorded to ensure good communication.
• Medicines were generally well managed, although improvements could be made to the way prescriptions were stored.
• 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.
• Data showed that that clinicians assessed patients’ needs and delivered care and treatment in line with current legislation.
• The practice had a programme of quality improvement activity and completed clinical audits although they had not been reviewed to test the effectiveness and appropriateness of the care provided.
• Staff spoken with confirmed they received regular training; however the training records were not up to date to confirm this.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Interpretation services were available for patients who did not have English as a first language.
• Generally patients found the appointment system easy to use and reported that they were able to access care when they needed it. Some patients reported they found it difficult to book an appointment.
• Most of the 26 patient Care Quality Commission comment cards we received were positive about the service experienced.
• Leaders had the capacity and skills to deliver good care. They aspired to provide safe, good quality and compassionate care. However, some systems were not effective for monitoring and reviewing policies and procedures and ensuring good record keeping and communication within the staff team
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed

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

The areas where the provider should make improvements are:

• A record should be kept of discussions held about patients’ health care issues.

• Information should be provided in different languages to support patients who do not have English as a first language.

• Regular fire drills should be carried out.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

During our inspection we spoke with the practice manager, two doctors, the practice nurse and two receptionists. We also spoke with five patients.

Patients told us they were given enough privacy during their visits to the practice and were treated respectfully by staff. They all spoke positively about the practice. Their comments included “They’re like old fashioned doctors here. I would always recommend here”.

We saw that all areas of the practice were clean. Protective clothing such as disposable gloves were available and liquid hand wash, alcohol hand gel and paper towels were available in all consultation rooms.

The provider carried out the required checks for all staff prior to them starting work.

The doctors carried out patient surveys and clinical audits. The practice manager told us they carried out regular informal checks on the quality of the service they provided.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Monarch Medical Centre on 19 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring, responsive and safe services. It was also good for providing services for the populations groups we rate.

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.
• Risks to patients were assessed and well managed.
• 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.
• Information about services and how to complain was available and easy to understand, however there was no evidence of the system being put into practice.
• Patients provided varied feedback on accessing appointment, with a number of patients reporting difficulties getting through to the practice by telephone, however patients reported when they got appointments these were convenient.
• 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.

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

Importantly the provider should

• Ensure all staff receives regular refresher safeguarding training.
• Ensure staff acting as chaperones receive appropriate training and procedures follow professional guidance.
• Ensure none clinical staff have access to appraisals on an annual basis.
• Have systems in place to formally gather and act on the views of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice