We carried out an announced comprehensive inspection at Sina Health Centre on 8 January 2019 as part of our inspection programme.

At the last inspection in December 2017 we rated the practice as requires improvement for providing safe services because:

• Not all the required recruitment information had been obtained.
• A system was not in place to demonstrate that alerts with may affect patient safety had been received, recorded and acted upon.

At this inspection, we found that the provider had satisfactorily addressed these areas.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• The practice continued to support patients living with dementia and their carers through support meetings and providing information packs on dementia.
• The practice was undertaking work to tackle loneliness. A meeting had been organised at the end of January 2019 for patients who considered themselves lonely or socially isolated.

Whilst we found no breaches of regulations, the provider should:

• Review and update the health and safety risk assessment.
• Identify the outstanding training needs for staff and ensure completion.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (The practice was rated good at our previous inspection 1 October 2014).

The key questions are rated as:

Are services safe? – Requires Improvement

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 carried out an announced comprehensive inspection at Sina Health Centre on 5 December 2017. We carried out this inspection as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learnt from them and improved their processes.
• Risks to patients were assessed and well managed, with the exception of those relating to management of safety alerts and or alterations made to patient records in relation to medicines.
• The practice worked closely with other health and social care professionals involved in patient’s care. Regular meetings were held with the community nursing teams and palliative care teams to discuss the care of patients who were frail / vulnerable or who were receiving end of life care.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were usually able to access care when they needed it.
• The practice had reviewed the lower than average GP national survey scores and developed an action plan to address these.
• There was a focus on continuous learning and improvement at all levels within the practice. Staff were encouraged and supported to develop their skills or take forward their ideas, for example the dementia support meeting.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. For details, please refer to the requirement notice at the end of this report.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.

The areas where the provider should make improvements are:

• Update the chaperone policy to include where staff should stand during the examination.
• Check the information held on locum GPs is current and up to date each time they work at the practice.
• Review staffing to ensure there are sufficient reception / administration staff to meet the needs of the practice.
• Record the serial numbers of prescriptions on receipt at the practice.
• Review and risk assess the range of emergency medicines stocked.
• Implement a system for the review of patient records in relation to changes to medicines, for example, the addition of new medicine or deletion of uncollected prescriptions should be reviewed by the GPs.
• Introduce a structured induction programme for newly appointed members of staff.
• Continue to explore how the patient satisfaction scores in relation to consultations with a GP and accessing appointments from the National Patient Survey can be improved.
• Promote the extended hours appointments to raise patient awareness.

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 Sina Health Centre on 1 October 2014. The overall rating for the practice is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health.

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 processes 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.

• Staff were caring and treated patients with dignity and respect.

• The practice was aware that improvements were needed to the appointments system for non-urgent appointments and had considered ways of improving the system.

• Systems were in place to support staff; training was generally available and relevant to each role.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There were systems in place to monitor and improve quality.

• The practice proactively sought feedback from staff and patients and this was acted upon.

• The practice recognised the need to strengthen the process for recruitment of staff and made chages to their policy.

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

The provider should:

• Consider how assurance of staff knowledge and competency is gained in relation to the Mental Capacity Act 2005. Review the staff group knowledge and understanding regarding the chaperone process to ensure it reflects the 2013 published General Medical Council (GMC) guidance for ‘Intimate examinations and chaperones’.

• Further develop the Incident/significant event reporting, recording and monitoring process to ensure trends and lessons learnt are captured and shared internally, and where appropriate externally.

• Further develop the care planning process to support consistent care delivery.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice