Letter from the Chief Inspector of General Practice

This is a focused desk top review of evidence supplied by Peel House Medical Practice, for two areas within the key question safe conducted on 23 November 2016.

The practice was initially inspected on 22 July 2016. The inspection was a comprehensive inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). At that inspection, the practice was rated ‘good’ overall. However, within the key question safe areas were identified as requires improvement, as the practice was rated as requires improvementnot meeting the legislation at that time; Regulation 12 Safe care and treatment and Regulation 13 Safeguarding service users from abuse and improper treatment.

At the inspection in July 2016 we found there were shortfalls in relation to Safe care and treatment and Safeguarding service users from abuse and improper treatment.

The practice supplied an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation 12 Safe care and treatment and Regulation 13 Safeguarding service users from abuse and improper treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following this desktop review, we found the practice to be good in providing safe services. Overall, the practice is rated as good.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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 Peel House Medical Centre on 22 July 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.
• The practice was aware that risks to patients were not consistently assessed and well managed and had recruited a quality assurance officer to develop this area. For example infection prevention and control audits had not taken place, safeguarding policies and training were not up to date and not all areas of the practice had been risk assessed.
• 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. However, acknowledgements and responses to complaints were not in line with practice policy and NHS guidance.
• The practice had made significant changes to the appointment system to improve patient access and experience over the last two years, and many patients reported this had improved although there were still some who were not satisfied regarding access.
• 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 must make improvement are:

• Improve arrangements to keep staff and patients safe including:
• Ensuring all required risk assessments are carried out and procedures for the control of substances hazardous to health (COSSH) meet requirements.
• Revising safeguarding policies, procedures and training to meet NHS requirements.
• Reviewing the infection prevention and control policy to include ensure a full annual infection prevention and control audit is carried out for both branch sites with required actions prioritised and implemented.
• Provide Mental Capacity Act training and guidance for all staff, especially those working with vulnerable people.

The areas where the provider should make improvement are:

• Provide chaperone training for all staff who carry out the role.
• Update the business continuity plan to include actions and responsibilities for the continued provision of care should the building be compromised or inaccessible.
• Review and implement management arrangements to ensure all staff have an appraisal annually and all required training is completed and recorded.
• Clinical prescribing protocols should be written to ensure consistency between all GPs and locum GPs.
• Introduce a local plan to ensure that continuous improvement activity including two-cycle clinical audit is undertaken consistently.
• Follow the local policy to ensure that complaints are acknowledged, investigated and responded to in line with NHS Guidance.
• Review the recruitment policy and locum policy to include ensuring that relevant checks are made on all locum staff including existing locum GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with four patients, one GP, the senior manager, the practice manager, two receptionists, an administrator and a practice nurse. We also spoke with two patients who were members of the Patient Participation Group (PPG). We did not visit the 'branch' surgery during this inspection.

Patients told us they were happy with the service, treatment and advice they received. They told us they were fully involved in discussions and decisions about their treatment. Comments included, "I can get everything related to my health sorted in the one place; that is very good for me" and "It's a good service; I'm very happy".

Patients told us they could request an appointment either by dropping into the practice, by booking on line or by telephoning the practice and speaking with a receptionist. We were told appointments 'slots' had been extended to ensure patients with more complex needs had time to discuss their condition without feeling rushed. The practice opening times had also been extended.

Staff received induction and training to undertake their roles. Records showed most staff had undertaken training in safeguarding and additional training was planned. This should help staff to recognise and act when patients were at risk of abuse or neglect.

There were effective systems in place to monitor the quality of service provision. We found patients' views had been taken into account in the way the service was provided.