Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Avenue Medical Centre on 4 July 2016. The overall rating for the practice was requires improvement due to breaches of legal requirements. After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to:

• Regulation 12 (RA) Regulations 2014, safe care and treatment.
• Regulation 17 HSCA (RA) Regulations 2014, good governance.

The full comprehensive report of the inspection on 4 July 2016 can be found by selecting the ‘all reports’ link for Park Avenue Medical Centre on our website at www.cqc.org.uk .

This inspection was a focused follow up inspection carried out on 18 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 4 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as ‘Good’.

From the inspection on 4 July 2016, the practice was told they must:

• Ensure arrangements were in place for identifying, assessing and mitigating risk in relation to non-clinical staff undertaking chaperone duties. This included risk assessment of whether DBS checks were required.
• Implement a system to ensure patients prescribed with high risk medicines were monitored appropriately.
• Ensure a Legionella risk assessment was undertaken and arrangements were in place to identify, assess and manage all risks associated with the premises.

We also told the practice that they should make improvements to the follows areas:

• Review how significant events and incidents were identified, documented and learning was shared.
• Continue to monitor Quality and Outcomes Framework (QOF) exception reporting to ensure clinical effectiveness.
• Review the arrangements for making contact with bereaved families to offer appropriate support.

Our key findings were as follows:

• Systems were in place for identifying, assessing and mitigating risk in relation to non-clinical staff undertaking chaperone duties. Non clinical staff that undertook chaperone duties had been checked through the Disclosure and Barring Service (DBS) and trained for this role.
• The practice had made the necessary changes to their procedures for managing high risk medicines. Patients prescribed with high risk medicines were now monitored appropriately.
• The practice confirmed that following a Legionella risk assessment by an external agency arrangements were in place to manage the risks associated with the premises.
• The arrangements for reporting significant events and incidents had been strengthened with specific improvements made to the system for identification documentation and sharing of learning points.
• A protocol was in place to monitor and manage the exception reporting process in relation to the Quality and Outcomes Framework (QOF).

• A protocol was in place to ensure contact with bereaved families to offer appropriate support.

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 Park Avenue Medical Centre on 4 July 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• There was an open approach to safety and a system in place for reporting and recording significant events.
• We found some risks to patients were assessed and well managed, with exceptions. These included those relating to Disclosure Barring Service (DBS) checks for non-clinical staff undertaking chaperone duties, assessment of the risk of Legionella and regular monitoring of those prescribed with high risk medicines.
• 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Whilst patients said they found it difficult to make an appointment by telephone, patients said they were able to see a named GP. There was continuity of care, with urgent appointments available the same day for those who needed them.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The premises had been extensively renovated.
• There was a clear leadership structure and staff said they felt supported by management. The practice proactively sought feedback, which it acted on.
• The provider complied with the principles of the duty of candour.

The areas where the provider must make improvement are:

• The provider must ensure the arrangements are in place for identifying, assessing and mitigating risk in relation to non-clinical staff undertaking chaperone duties. This includes risk assessment of whether DBS checks are required.

• Implement an effective system to ensure patients prescribed with high risk medicines are monitored appropriately.

• Ensure a Legionella risk assessment is undertaken and arrangements are in place to identify, assess and manage all risks associated with the premises.

The areas where the provider should make improvement are:

• Review how significant events and incidents are identified, documented and learning is shared.

• Continue to monitor Quality and Outcomes Framework (QOF) exception reporting to ensure clinical effectiveness.

• Review its arrangements for making contact with bereaved families to offer appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This was a follow-up inspection to the inspection we carried out on 8 October 2013, when we identified concerns regarding the storage of patient records at the practice.

Following our earlier inspection the provider sent us an action plan which identified what actions they would take to address the concerns. When we visited the practice again on 16 September 2014, we found that the provider had implemented improvements relating to the storage of records.

We spoke with patients of the practice and they gave us mixed reactions to the practice. We received some very positive comments about some of the staff at the practice in particular two GP's. Patients told us that some of the GP's were very supportive and listened to any problems they had. One person told us that their GP had supported both them and a family member for a long time and that they couldn't thank their GP enough.

Three patients told us that they were unhappy with the continuity of care at the practice. They told us that they could rarely get to see the same GP and that they felt that they had to explain time and time again what had happened to them.

We spoke with patients about their appointments with the GP and they told us that they were always well informed as to what was wrong with them. They also told us that the GP explained the different ways in which they could be treated and they were able to make a decision on what they would like to try. Patients also told us that if they required an examination the GP gave them privacy to make themselves comfortable prior to examination.

We spoke with patients who used the service and they told us that they felt safe at the practice. We did however find some concerns around record keeping at the practice and checks conducted on staff.