This practice is rated as Good overall. (Previous inspection 25 April 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Parkview Medical Centre on 17 July 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was to follow-up on breaches and to check whether the provider had met their action plan from the previous inspection. The inspection was also to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

Previously we carried out an announced comprehensive inspection at Parkview Medical Centre on 25 April 2017. The overall rating for the practice was Requires Improvement. The full comprehensive report on Parkview Medical Centre can be found by selecting the ‘all reports’ link for on our website at .

At this inspection we found significant improvements had been made and the breaches made at the last inspection had been met.

Overall the practice is now rated as Good.

At this inspection we found:

• A review of staffing levels to support the running of the service had been undertaken and secretarial and administration staffing hours had been increased. The service was in the process of advertising for a full time practice nurse post.
• The practice had reviewed the safety of prescribing after consultation with the medicine management team.
• A review of emergency medication had been undertaken and emergency medication was well signposted.
• Recruitment records did not contain all the necessary information to demonstrate the suitability of staff.
• In some instances, it was up to five days before a two week wait (2WW) referral had been made.
• Staff had had been provided with up to date training and annual appraisals to support them in their roles and responsibilities.
• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.
• We saw that information was held in line with the General Data Protection Regulation (GDPR) and training had been provided to staff. GDPR is a European regulation enforceable from May 25, 2018. It aims at protecting personal data for all individuals within the EU.
• Weekly practice meetings have been implemented in addition to a monthly clinical meeting.
• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The majority of patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice sought patient views about improvements that could be made to the service; including having an active patient participation group (PPG) and acted, where possible, on feedback.

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.

The areas where the provider should make improvements are:

• Monitor the new system that was implemented following the inspection to tighten up two week referrals.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkview Medical Practice on 3 February 2016. Overall the practice is rated as requires improvement.

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

• A system was in place to record significant events. However, only a small number of events had been reported and we saw an example of a complaint which should have been recorded, investigated and responded to as a significant event.

• The number of appointments provided weekly in relation to the size of the patient population indicated that clinical staffing levels were not sufficient and required review. This was reflected in feedback from patients. Patients found it easy to get through to the surgery by phone. However, patients did not always find it easy to get an appointment with a GP.

• Systems were in place to deal with emergencies and all staff were trained in basic life support. However, the practice did not hold a sufficient supply of emergency medicines in line with good practice guidance. There was no risk assessment in place to support the lack of emergency medicines.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were in place and there were regular checks on the environment and on equipment used.

• The practice used performance indicators to measure their performance. Data showed that the practice achieved results comparable to and above other practices locally and nationally. For example for supporting patients with long term conditions and mental health needs.

• Staff were supported in their roles and kept up to date with training and professional development.

• The practice worked in collaboration with other practices locally and they participated in enhanced services to provide better outcomes for patients.

• The GPs carried out clinical audits and the results of these were used to improve outcomes for patients.

• Systems for disseminating best practice guidance and arrangements for clinical governance were not well established.

• Overall, patients said they were treated with care and concern and involved in decisions about their care and treatment. However, national patient survey results showed that the practice received lower than the local and national average scores in these areas.

• The practice provided a range of enhanced services to meet the needs of the local population.

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• Complaints were investigated and responded to in a timely manner. However, the practice were not demonstrating what actions had been taken in response to complaints or demonstrating that they were learning from complaints and patient feedback.

Areas where the provider must make improvements are:

• Implement a system to ensure dissemination and implementation of best practice guidance.

• Implement a clinical governance system to assess the quality of care and treatment provided and drive improvement. To include ensuring significant events have been captured, appropriately investigated and acted upon.

• Ensure prescribing practices are reviewed and patient monitoring is appropriate.

• Ensure the complaints procedure includes the required information for dealing with complaints at different stages and demonstrate that learning from complaints has been acted upon to improve patients’ experiences of the service.

• Ensure there is an effective system in place for responding to medical emergencies.

• Ensure a review of staffing is carried out to establish if there are sufficient numbers of clinical and non-clinical staff deployed at the practice.

• Ensure all clinicians are fully aware of the guidance for consent for children and young patients to ensure patients are provided with the appropriate care and treatment.

Areas where the provider should make improvements:

• Review how patient data is used to provide/ generate information on the needs of the patient population, to identify patients' needs more readily and to be able to monitor more effectively the data used to drive improvements in outcomes for patients.

• Review training needs to support the effective management of information governance and data protection.

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 View Medical Practice on 3 February 2016. The overall rating for the practice was ‘requires improvement’. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Park View Medical Practice on our website at www.cqc.org.uk.

At our previous inspection in February 2016 we rated the practice as ‘requires improvement’ for each of the key questions we inspect against. The practice was therefore rated as ‘requires improvement’ overall. We issued five requirement notices to the provider relating to; clinical effectiveness, medicines prescribing, emergency medicines, the management of complaints, staffing levels and for a lack of effective systems being in place for assessing and monitoring the quality of the service and governing the practice.

This inspection visit was carried out on 25 April 2017 to check that the provider had met their plan to meet the legal requirements.

The findings of this inspection were that whilst the provider had taken some action to meet the requirement notices these were not always sufficient to make a significant improvement and as a result the practice continues to be rated as requires improvement.

Our key findings were as follows:

• Improvements had been made to the way significant events were managed and a periodic review of events was now in place. However, we saw a number of examples where the provider had failed to recognise an event as a significant event and therefore they had not taken action to investigate the matter or to put systems in place to prevent a reoccurrence.

• Improvements had been made to how complaints were managed. However, there was room for continued improvement as we saw that not all complaints had been fully explored and some issues should have been recognised as a significant event and managed as such.

• The provider had taken action to make improvements to the range and storage of emergency medicines. However, not all emergency medicines could be readily located by staff. Not all staff had been provided with up to date training in basic life support.

• The GPs were able to demonstrate how they used best practice guidance in the care and treatment provided to patients.

• The practice used performance indicators to measure their performance. Data showed that the practice achieved results comparable to other practices locally and nationally for outcomes for patients.

• The provider had carried out a review of staffing and had increased clinical staffing.

• There were gaps in staff training as not all staff had undergone training or updated their training in key topics such as safeguarding, basic life support and infection control.

• The majority of patients we spoke with said they were treated with care and concern and involved in decisions about their care and treatment. However, a number of patients were not complimentary about some of their experiences during consultation with GPs.

• National patient survey results showed that the practice received lower than local and national average scores for patient experience of the care and treatment provided.

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• Infection control practices were in place and there were regular checks on the environment and on equipment used.

• The practice provided a range of enhanced services to meet the needs of the local population.

• Clinical meetings had been introduced since our last inspection visit. However, arrangements for clinical governance required further improvement.

• Patient records were not maintained securely in line with data protection legislation.

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.

• Review significant events reporting to be clear about what constitutes a significant event and to ensure events are being captured and acted upon. To include clearly recording the investigations behind significant events.

• Improve the arrangements for the monitoring of patients on high risk medicines and for patients who require an annual review of their medicines.

• Review the arrangements for storing emergency medicines and for training staff in dealing with medical emergencies.

• Ensure the arrangements for protecting information are in line with data protection legislation.

• Ensure all staff are provided with up to date training to support them in their roles and responsibilities.

Areas where the provider should make improvements:

• Review staffing levels to ensure there are sufficient numbers of staff to support the running of the service.

• Use the electronic patient records system more effectively to provide information on the needs of the patient population.

• Improve the system for managing patient safety alerts to demonstrate the actions taken in response.

• Improve the standard of administrative/practice process record keeping to ensure appropriately detailed records are maintained.

• Increase the number of identified carers to ensure these patients are provided with information about the support available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice