This practice is rated as Good overall. (Previous inspection 20 June 2017 Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We undertook a comprehensive inspection of Sheldon Medical Centre on 20 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as Requires Improvement for providing safe, responsive and well led services. The practice was required to produce an action plan to detail how they would meet the legal requirements in relation to the breaches in regulations that we identified in the June inspection. The full comprehensive report on the 20 June 2017 inspection can be found by selecting the ‘all reports’ link for Sheldon Medical Centre on our website at www.cqc.org.uk.

We undertook a further announced comprehensive inspection on 28 February 2018 to check that the provider now complied with legal requirements. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. We saw that when incidents did happen, the practice discussed these at clinical meetings and learned from them and improved their processes as a result.
• The practice routinely 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 and the National GP Patient Survey results reflected this.
• In addition comment cards we received reported high levels of satisfaction with the services at the practice and patients we spoke with also provided positive feedback.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. However we did receive feedback that it was sometimes difficult to get through to the practice on the telephone and the National GP Patient Survey results reflected this.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. This is a training practice who were currently supporting a final year medical student who reported they felt well supported.

The areas where the provider should make improvements are:

• Continue to monitor patient satisfaction rates in particular in relation to access to appointments.
• Continue to monitor and improve cancer screening rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously inspected Sheldon Medical Centre on 10 November 2014. As a result of our inspection visit, the practice was rated as good overall with a requires improvement rating for providing safe services; the practice was rated good for providing effective, caring, responsive and well led services. A requirement notice was issued to the provider. This was because we identified a regulatory breach in relation to regulation 12, Safe care and treatment. We identified some areas where the provider must make improvements and some areas where the provider should make improvements.

We carried out an announced comprehensive inspection at Sheldon Medical Practice on 20 June 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2014. You can read the reports from our previous inspections, by selecting the 'all reports' link for Sheldon Medical Centre on our website at www.cqc.org.uk.

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

• The practice had one shared patient list across the main practice at Arran Medical Centre and the partner practice at Sheldon Medical Centre, patients could access services at both sites if they wanted to. Most patients we spoke with during our inspection were not familiar with the main practice and were not aware that they had the option to go there also.

• We saw that in most cases medicines were prescribed in line with national prescribing guidelines, however we found that in one case there was continued prescribing of a specific opiate medicine with no rationale in the patient’s record.

• There were some arrangements in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs. However, we found that previously when the practice nurse was absent from the practice a full nursing service was not provided during this period.

• We found that one of the practice’s emergency medicines had expired in November 2016. Although this was recorded as a significant event, there was no assurance given to indicate if the emergency medicine had been replaced. Following our inspection the provider clarified that the emergency medicine was not needed in the practice however, no formal risk assessment was provided to support how risk was managed in the absence of the emergency medicine used to treat pain.

• The practice was rated below average for most of the areas covered in the national GP patient survey published in July 2016. Although the practice had developed an action plan in response to the survey, there was no evidence to demonstrate if these changes had been effective. Results from the survey published in July 2017 were provided by the practice following our inspection. These results highlighted some improvements around accessing the service, most results for this area however remained below the local clinical commissioning group (CCG) and national averages.

• The management team explained that they encouraged a culture of openness and honesty. However based on our evidence overall, we found that sometimes there was not an open culture and staff were not always supported in the practice.

• Most clinical performance data was above average across areas such as diabetes care. However, breast and bowel cancer screening rates were below average and although some steps were being taken to improve uptake, the practice was unable to demonstrate if this had been 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 sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

The areas where the provider should make improvements are:

• Consider alternative methods to improve cancer screening rates overall.

• Consider working on areas to improve as identified from patient feedback and the national GP patient survey and assess the effectiveness of improvement as part of a continuous improvement cycle.

• Engage with patients and utilise the patient participation group so that patients are at the heart of improvement in the practice.

• Ensure that patients are informed about alternative options available to them, such as accessing services and clinical care at the main practice, Arran Medical Centre.

• Take steps to improve exception reporting for patients suffering with dementia.

• Improve the number of health reviews of patients with a learning disability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We completed a comprehensive inspection at Sheldon Medical Centre on 10 November 2014. Overall the practice is rated as good.

Specifically, we found the practice required improvement for providing safe services. It was good for providing effective, caring, responsive services and for being well led. We found the practice was good for providing services for the six population groups.

Our key findings were as follows:

• Patients were protected from the risk of abuse and avoidable harm. The staff we spoke with understood their roles and responsibilities and there were policies and procedures in place for safeguarding vulnerable adults and children.

• Patients received care and treatment which achieved good outcomes, promoted a good quality of life and was based on the best available evidence. Systems were in place to review the care needs of those patients with complex needs or those in vulnerable circumstances.

• The practice worked collaboratively with other agencies and regularly shared information to ensure good, timely communication of changes in care and treatment.

• Staff were aware of their roles and responsibilities and also of the lead roles of others. Staff worked well as a team and good management support systems were in place.

However, there were also areas of practice where the provider must make improvements:

The areas where the provider must make improvements are:

• Ensure that systems in place for the storage of medication are robust, including provision of suitable cold storage and appropriate policies and systems to demonstrate that medications are appropriately and securely stored. Ensure that guidance regarding the action to take in case of system failure is available for staff.

In addition the provider should:

• Ensure that documentary evidence is available to demonstrate the actions taken to address any significant events, incidents or accidents that have occurred.

• Ensure that control of substances hazardous to health (COSHH) risk assessments are undertaken to identify the risk associated with the use of substances hazardous to health and detail any mitigating actions to reduce the risk.

• Ensure that staff including the GP have up to date knowledge of the Mental Capacity Act 2005 and how to complete assessments of patient’s mental capacity. Also ensure that staff are aware of Gillick competencies and how to apply these for relevant patients at the practice.

• Review arrangements for maintaining business continuity in the event of emergencies such as loss of power, flood, computer failure or staffing crisis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice