Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Plashet Medical Centre on 16 January 2017. Overall the practice is rated as good.

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

• The practice demonstrated an effective system to report and investigate significant events. Learning was identified to improve practice and safety processes.
• Risks to patients were assessed and well managed, including through medicines management, safeguarding and emergency planning.

• 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.
• There was evidence of continuous multidisciplinary working to meet the complex needs of patients, including vulnerable young people and those who received palliative care.
• Health promotion and empowering patients to live healthy lives was embedded in the approach to care of the practice. This included in care plans and in multidisciplinary meetings and the practice provided evidence of impact.
• Patients provided positive feedback about the caring nature of staff and said they took the time to listen to their concerns. We saw staff treated people with compassion, dignity and respect and involved them in care planning 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.
• 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 whole practice team demonstrated a consistent approach to monitoring quality and identifying opportunities for improvement through multidisciplinary clinical governance structures.
• The senior team had engaged a specialist organisation to work with staff following a period of high turnover and disruption. This enabled them to build a new team that was demonstrably passionate and motivated about the service and the practice’s patients.

We found areas of outstanding practice:

• A healthcare assistant led a dedicated health promotion service to empower patients with healthy living knowledge and resources. There was evidence of the positive impact of this work from significantly improved qualitative patient feedback and patient outcomes such as the detection of undiagnosed tuberculosis as a result of a pilot scheme.
• The practice had been awarded gold-standard accreditation by the LGBT Foundation for their work in fostering a safe and welcoming environment for gay, lesbian, bi-sexual and transgender patients. Specialised resources were provided through the Pride in Practice programme.
• Staff demonstrated a continuous track record of adapting services to individual needs. This included vaccination advice in multiple languages for patients who planned to attend religious pilgrimages and specialised sexual health and cancer advice individualised to sexual identity.

We found areas of improvement that the practice should make:

• The practice should ensure carers are proactively identified within the patient population and that these people are engaged with to access support services.
• All GPs should be trained to safeguarding adults and children level three.
• The practice should continue to work towards improved access and ensure the results are evidenced in the outcomes of patient surveys.
• The practice should implement a strategy to improve the uptake of breast screening to bring this in line with local and national averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our last inspection on 25 October 2013 we found the practice had not taken reasonable steps to protect children and vulnerable adults from the risk of abuse. Staff were not up to date with safeguarding children and vulnerable adults training and not all staff were aware of the procedure for reporting any concerns they might have about a patient being at risk of abuse or neglect.

At our last inspection we also found that the practice did not have available all the information required about people employed by the practice to provide treatment and care to patients to demonstrate they are of good character, have the necessary qualifications, skills and experiences, and are physically and mentally for the work.

The practice wrote to us on 26 November 2013 about action the practice would take to become compliant with these essential standards by 31 January 2014.

At our inspection on 03 September 2014 we found the practice was meeting these essential standards. Reasonable steps had been taken to protect children and vulnerable adults from the risk of harm. The practice had completed new Disclosure and Barring Service (DBS) and verified the identification and qualifications of all staff working at the practice, and had put in place to ensure that all required information was held on record for all new employees.

We did not speak to patients as part of this inspection because of the nature of the compliance actions we were following up.

At the time of our inspection the provider did not have a registered manager in post.

Patients said they were happy with the quality of the service. One patient said, "they are fantastic and the staff are lovely." Another said, "they are so loving and make you feel happy."

Patient told us they received adequate information about treatment options and that staff treated them with respect. Patients said “it’s up to you” and “they respect my choices.”

We found the practice used a system to indicate each patient's specific needs and medical history. One patient told us, “the doctor looks at your records and gives you what you need.” There were arrangements in place to deal with foreseeable emergencies.

Patients told us they felt safe using the service and there were procedures in place for the reporting of suspected abuse. However, not all staff were familiar with these and staff did not have up to date training in safeguarding children and vulnerable adults from abuse.

Staff told us that appropriate checks had been done before they started work, but we did not find evidence of this in staff files.

Patients told us they had the opportunity to complete surveys or give verbal feedback about the service. We found evidence that patients' views were discussed and acted on. The practice had mechanisms to discuss and learn from incidents.