We carried out an announced comprehensive inspection at OHP-Poolway Medical Centre on 15 January 2019 as part of our inspection programme.

The practice was previously inspected under the previous provider in November2017 and was rated good overall with a Requires improvement in Responsive.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall. We have rated all population groups as requires improvement.

We rated the practice as requires improvement for providing safe, responsive and well-led services because:

• The overall governance arrangements to support high quality sustainable care was not effective.
• Management information was not always readily available when required.
• Not all staff were fully aware of policies and procedures in place and many of these were under review.
• Risks were not always effectively considered and mitigated against.
• Prescription pads were not kept fully secured and the management of prescription pads was not effective as there was no auditable process to prevent misuse.
• Systems for recording and reporting incidents were not clearly embedded throughout the practice.
• Patient feedback from the national GP survey shows that patients were happy with their consultations. However, experience of making an appointment and satisfaction with appointment times were significantly below local and national averages.

We rated the practice as good for providing caring and effective services because:

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The areas where the provider must make improvements are:

• 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:

• Improve knowledge and understanding in relation to incident reporting.
• Review the accuracy of the carers register to ensure support is appropriately targeted.
• Consider how the practice could support improved uptake of all national cancer screening programmes.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good.

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? – Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at OHP-Poolway Medical Centre on 10 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice was faced with a number of challenges outside their control which had placed additional pressure on staff and the service. This included two practice relocations since registering with CQC and the long term leave of one of the partners. The latest relocation of services was in September 2017. These challenges had generally been well managed by the practice to ensure continuity of service provision.
• The practice had systems and processes in place to keep patients safe and safeguarded from abuse. This included safeguarding arrangements, management of infection control, medicines and for unforeseen events.
• At the time of our inspection, the tenancy agreement was due to be signed and the practice was working with the landlord to ensure the safety of the premises. Refurbishment was in progress and various risk assessments had been undertaken in relation to the premises.However, we found risk assessments in relation to fire safety were not sufficiently detailed and were in need of review.
• The practice was reliant on regular locum staff , The principal GP worked flexibly to ensure cover was provided.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines. They worked with a range of health and care professionals in the delivery of patient care.
• Patient outcomes in relation to the quality outcome framework showed the practice was performing in line with other practices locally and nationally for many long term conditions.
• Feedback from patients from the national GP patient survey and the CQC patient comment cards showed that they felt they were treated with compassion, kindness, dignity and respect and felt involved in their care and treatment. Patient satisfaction with consultations with clinical staff and helpfulness of reception staff was above local and national averages.
• However, patient feedback also indicated that they did not always find it easy to access care when they needed it. The practice had started making improvements such as the recent piloting of a new telephone systems.
• We found systems for record keeping to support the delivery of the service was not always effective for example the recording of action taken in response to safety alerts, information relating to staff including training and registration and meetings.

The areas where the provider should make improvements are:

• Review systems and processes for recording incidents occurring within the practice (positive and negative) to support practice learning.
• Review systems for monitoring staff registration with professional bodies to ensure they remain up to date.
• Review fire safety in the premises to ensure an adequate assessment of risk has been undertaken and action taken in response.
• Improve record keeping in relation actions taken in response to staff training, staff information, practice meetings and safety alerts.
• Take action to address areas where the practice is an outlier in relation to patient outcomes and prescribing.
• Continue to take action for improving patient satisfaction in relation to access to appointments and monitor progress to ensure progress is being made.
• Make greater use of service improvement activity such as clinical audit to support service improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice