At our last inspection in November 2013 we found that the provider was not compliant with standards relating to infection prevention and control. We found that risk assessments and audits to assess compliance with hand hygiene, waste management, and general cleanliness had not been carried out to monitor the quality of practice in line with the requirements of the Health and Social Care Act 2008 – Code of practice on the prevention and control of infections and related guidance.

During this inspection we looked again at standards relating to infection control. We saw that a risk assessment had taken place in January 2014 which identified risks and actions to be undertaken. We found that a follow up audit of general cleanliness had taken place in March 2014. The audit detailed what had been checked, by whom and when the checks had taken place. There was a procedure in place for conducting future audits to ensure that the provider continued to be assured that appropriate standards of cleanliness and hygiene in relation to the premises were being maintained. We saw that actions had been taken in response to issues found during the routine auditing process.

We spoke with nine patients who used the service. They told us that they felt able to openly discuss the reason for their visit with clinical staff and that they were given sufficient information on any treatment required. One patient told us "The doctor listened to my concerns and we have agreed the course of action."

All patients we spoke with confirmed they could get an appointment if they needed one, and understood that it might be with any available GP. However, they told us it was increasingly difficult to get an appointment slot via the telephone booking system. Staff told us that when these appointments had been filled patients were given the option of a telephone consultation with the on-call GP, to provide advice or another suitable appointment slot.

People's diversity, values and human rights were respected. There were a number of policies in place in relation to respecting people's cultural and religious beliefs. All appointments took place in private and people were made aware of the chaperone policy. We observed notices in each consultation room.

Patients told us they were happy with the care and treatment provided. One patient told us “the medical support is good here. It always has been throughout my 60 years of attending this medical centre.” Patients’ needs were assessed and care and treatment planned and delivered in line with their individual plan of care.

There were arrangements in place to deal with foreseeable emergencies.

Patients were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Patients told us they felt safe using the service and had confidence in the doctors, nurses and healthcare assistants at the practice.

Patients we spoke with thought that the medical centre was clean. For example, one patient described the medical centre as “relatively clean and tidy."

Disposal of sharp instruments, such as needles, were safely managed. All medical devices and instruments used in the practice were single-use and were not reused. The medical centre was cleaned daily by outside contractors. However, the provider may find it useful to note that the standards of cleaning were not being monitored through a regular audit of cleanliness to ensure that the medical centre met appropriate hygiene standards.

We did not see evidence of a formal risk assessment of the practice in relation to infection prevention and control. Without a formal assessment of infection control risks in respect of the practice the provider could not be assured that appropriate measures were in place and that patients were protected from the risk of acquiring a health care associated infection.

Patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The medical centre had a managing medicines policy and an immunisation/vaccination protocol in place

All nine patients we spoke with were unaware of the provider’s complaints policy/procedure and also unclear about how and to whom they should raise their complaints. However, patients told us they would speak to their GP if they had any complaints or concerns or alternatively they would speak with reception staff.

Patients had their comments and complaints listened to and acted on. We looked at the complaints for each GP for the past year. All complaints were recorded appropriately in accordance with the medical centre's policy.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oak Lodge Medical Centre on 30 March 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 should make improvement are:

• Review the cleaning schedule to include carpets in clinical consultation rooms.

• Take action to improve patient satisfaction in relation to access to the service and monitor the impact.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice