Letter from the Chief Inspector of General Practice

We carried out an unannounced focussed inspection at Oadby and Wigston Walk-In Medical Centre on 31 March 2016. The inspection was carried out because we had

received information of concern relating to the safe storage, stock control and responsibility for managing medicines, infection control procedures, managing emergencies and equipment, safeguarding and learning from significant events. Concerns were also raised regarding safe staffing levels, complaints management and governance procedures.

We found the service was not meeting some of the fundamental standards and had breached regulations.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events although some staff were not aware of the process.
• 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.

• The complaints policy and procedures were in line with recognised guidance and contractual obligations for GPs in England. Information about services and how to complain was not available for patients within the practice.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Medicines were stored securely but were not easily accessible to all staff. Some medicines were past their expiry dates.

• Processes were lacking for checking the expiry dates of stored medicines, the medicines fridge temperature, security of blank prescription forms and the emergency equipment.

The areas where the provider must make improvement are:

• Implement a process to ensure that patient safety alerts are acted upon and the process is audited to show continued actions are taken for patients to receive treatment in accordance with best practice.

• Ensure that emergency equipment and oxygen is checked to see if it is in date and fit for use.

• Ensure that emergency medicines are easily accessible to all members of staff and processes are in place to check the expiry dates of medicines and to monitor the medicines fridge temperature. Ensure blank prescriptions are stored securely at all times and there is a system in place to monitor the use of the blank prescription forms.

• Improve security at the reception desk to ensure the public do not have access to patient information and paper records.

The areas where the provider should make improvement are:

• Ensure all staff are aware of how to access policies and procedures and know how to log incidents and significant events.

• Be clear who the infection control lead is and ensure that clinical waste is disposed of correctly.

• Remove equipment that was left by the previous provider that is not for current use.

• Formalise the process for identifying if a patient requires a GP or nurse consultation.

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 Urgent Care Centre Oadby & Wigston Walk In Medical Centre on 15 and 16 March 2017. Overall the service 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 a system in place for reporting and recording significant events. A monthly bulletin was sent to all staff that outlined any lessons learnt from significant events.
• The service had clearly defined and embedded systems to minimise risks to patient safety.
• Patient safety alerts and MHRA (Medicines and Healthcare products Regulatory Agency) alerts were received centrally by the Vocare clinical governance lead and disseminated as appropriate to the service. However, we found that staff were not aware of one alert we asked to review in relation to the prescribing of emergency contraception that was issued in September 2016.
• Staff were aware of current evidence based guidance.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Performance data showed that 96% of people who arrived at the service completed their treatment within 2 hours. This was greater than the target of 95%.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Results from a survey carried out by an external company showed that 86% of respondents felt the Urgent Care Centres were easy to get to. Patients could access the service either as a walk in patient, via the NHS 111 service or by referral from a healthcare professional.
• Patients we spoke with told us they were satisfied with the care provided by the service and said their dignity and privacy was respected.
• All the locations had good facilities and were well equipped to treat patients and meet their needs.
• There was a clear leadership structure and the majority of staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• A small number of staff raised concerns regarding staffing levels and support at one of the locations, however we saw that the leadership team had developed infrastructures to ensure improvement and were aware that there had been a period of unsettle due to recent organizational change.
• The service had a staff recognition scheme. Staff members were encouraged to nominate their colleagues for a reward if they had exceeded what was expected of them or if they had made a recommendation to improve the service that had been implemented.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the service complied with these requirements.

The areas where the provider should improvements are:

• Review the process for the dissemination of MHRA (Medicines and Healthcare products Regulatory Agency) alerts to ensure staff are aware of all relevant alerts.
• Monitor the implementation of the staff meetings to ensure effective communication with all staff.
• Implement an initial assessment of patients to ensure they are safe to wait, where wait times are greater than 30 minutes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice