This practice is rated as requires improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

We carried out an announced inspection at Selden Medical Centre on 19 July 2018 as part of our regulatory functions. The inspection was planned to check whether the provider is 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.

At this inspection we found:

• The practice had recently been through several changes to its partnership, clinical staffing and management which meant that leadership and capacity had been reduced and systems and processes were not yet embedded.
• Practice leaders were aware of the issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
• 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 practice listened to and acted on patient views. For example, in response to GP patient survey feedback, improvements had been made to the appointment system.
• Patient feedback on the day of the inspection was positive in relation to the care and treatment received.
• Systems for managing risk so that safety incidents were less likely to happen were not always effective. For example, learning from incidents and the action taken were not consistently shared or followed up.
• The practice did not have an effective system for ensuring patient and medicine safety alerts were acted on.
• Practice performance against the quality and outcomes framework (QOF) indicators for patients with long term mental health conditions and patients with high blood pressure was significantly lower than the local and national average. Exception reporting rates were significantly higher than average for several indicators. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• The practice performed below the national target for two out of the four childhood vaccines.
• Arrangements for ensuring appropriate standards of cleanliness and hygiene were maintained were not always effective.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure patients are protected from abuse and improper treatment.

The areas where the provider should make improvements are:

• Put a system in place to ensure the ongoing registration of clinical staff is checked and regularly monitored.
• Continue to implement measures to improve telephone access and appointment availability.
• Provide awareness training for all staff on the ‘red flag’ sepsis symptoms that might be reported by patients and how to respond.
• Improve the identification of carers so that they can be offered appropriate support.
• Implement a programme of continuous improvement.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected no longer than six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service must improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.