Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Preston Medical Centre on 16 November 2016. The overall rating for the practice was Good, with a rating of Requires Improvement in the Safe domain. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Preston Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 25 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 November 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection..

Overall, the practice is now rated as Good.

Our key findings were as follows:

• The practice had taken significant steps to ensure that they met infection control standards as per recommendations from the infection control audit and findings at our previous inspection.
• Comprehensive infection control audits were now being carried out in conjunction with the designated infection control nurse.
• The practice had carried out a Control of Substances Hazardous to Health (COSHH) risk assessment.
• Disclosure and Barring Service (DBS) checks had been carried out on newly employed staff and non-clinical staff who undertook chaperoning duties.
• Patient identifiable information was securely stored and staff had signed confidentiality agreements and had undertaken information governance training.
• The practice had installed a pull cord in the disabled toilet for patients to call for assistance.
• The practice had addressed risk in all areas of the practice and had taken action to address this; for example, they replaced a damaged examination couch and replaced flooring in one of the clinical rooms.
• The practice had installed blind loop cords in the patient toilet.
• The practice had improved the monitoring of patients with diabetes. They carried out a monthly virtual ward round and worked together with the diabetes specialist nurse

However, there were also areas of practice where the provider should make improvements.

Importantly, the provider should:

• Ensure the arrangements for identifying and controlling substances hazardous to health (COSHH) include all hazardous substances in the practice.

• Consider improving communication with patients who have a hearing impairment and review the requirements of Accessible Information Standard (AIS) as per national guidelines.

• Continue to review staffing arrangements to ensure that there is sufficient nursing cover to meet patients’ needs.

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 Preston Medical Centre on 16 November 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.
• Risks to patients were not always assessed and well managed especially in relation to confidentiality, infection control, staff recruitment and blind cords in clinical rooms. Some of the staff had not undertaken training appropriate to their roles.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs; however the patient and staff toilets were not clean and the patient toilet was not accessible to people with mobility issues.
• 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.

There were areas of practice where the provider must make improvements:

• Ensure that all staff receive infection control, information governance, fire safety and safeguarding adults training relevant to their role.
• Ensure that a comprehensive infection control audit is undertaken and that all the recommendations following the audit are actioned, the cleaning of medical equipment and the patient and staff toilets meet infection control standards and a control of substances hazardous to health risk assessment is undertaken and all the recommendations following the risk assessment are actioned.
• Ensure that all staff sign confidentiality agreements.
• Ensure that chaperone processes are in line with guidelines and undertake a risk assessment to ascertain if Disclosure and Barring Service (DBS) checks are required for all staff who undertake this role and DBS checks are undertaken before employing clinical staff or undertake a risk assessment before employing non-clinical staff.
• Ensure that the patient toilet is accessible for disabled patients and consider how patients would call for help from the patient toilet.

There were areas of practice where the provider should make improvements:

• Ensure risk assessments are completed for all areas within the practice.
• Ensure that all patient identifiable information is securely stored.
• Ensure that a hearing loop is available for patients with hearing impairments.
• Review staffing arrangements to ensure that there is sufficient nursing cover to meet patients’ needs.
• Review the arrangements for the monitoring of diabetes for patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice