Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Albans Medical Centre on 11 October 2016. The overall rating for the practice was requires improvement, and the practice was rated as inadequate for safety. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for St Albans Medical Centre on our website at www.cqc.org.uk.

Following the October 2016 inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulations 12 (Safe care and treatment), 17 (Good governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this announced focussed inspection on 25 April 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment and to carry out their roles effectively. Processes were in place to ensure that staff undertook training updates at the recommended intervals.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The partners were clear about the performance of the practice and we saw evidence of action they had taken to address areas of below-average performance. Data showed patient outcomes were comparable to the national average and the practice had improved their processes in order to address their previously high exception reporting rate.
• Clinical audits had been completed and we saw evidence of these being used to improve patient care.
• The practice had a number of policies and procedures to govern activity; these had been reviewed and amended following issues raised during the previous inspection.
• Information about services and how to complain was available and easy to understand; however, not all complaint responses included information about how the complaint could be escalated.

There were three areas of where the provider should make improvements.

The provider should:

• Continue to ensure that they are identifying carers so they can be signposted to appropriate support.
• Ensure that all complaint responses include details of how the complaint can be escalated.
• Continue to work to develop their Patient Participation Group.

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 St Albans Medical Centre on 11 October 2016. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, the process or recording discussions and learning from incidents lacked cohesion.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment, action had not been taken to address concerns with infection control practice, and medicines were not always stored in accordance with legal requirements.
• Data showed patient outcomes were comparable to the national average; however, the practice had excepted a higher than average proportion of patients from Quality Outcomes Framework indicators, and were unaware of this.
• Although some audits had been carried out, we saw no evidence that audit was being used to drive improvements to patient outcomes.
• Overall, staff assessed patients’ needs and delivered care in line with current evidence based guidance; however, the practice did not always have processes in place to ensure that patients were appropriately monitored, including patients being prescribed high-risk medicines and lack of recall systems for people referred for blood tests.
• Clinical staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment; however, not all non-clinical staff were up to date with mandatory training.
• The majority of patients said they were treated with compassion, dignity and respect and that they felt cared for, supported and listened to.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had a number of policies and procedures to govern activity; but we saw evidence that these were not always followed.

The areas where the provider must make improvements are:

• They must ensure that all staff have received the necessary mandatory training and that update training is undertaken at appropriate intervals.
• They must ensure that they follow their recruitment procedure and that their recruitment processes keep patients safe.
• They must ensure that they are carrying-out regular infection control audits and that action is taken to mitigate any risks identified.
• They must ensure that their repeat prescribing policy is followed by all staff and that processes for repeat prescribing are robust.
• They must ensure that processes are in place to monitor patients who require care, including the monitoring of patients taking high-risk drugs, and those who require further treatment or monitoring following tests.
• They must ensure that they are storing all medicines in accordance with legal requirements.
• They must ensure that they monitor the receipt and use of electronic prescription sheets.
• They must ensure that they are clear about the performance of the practice and that they are taking action to address areas where their performance falls below expected levels; in particular, they should improve care for patients with long term conditions, to reduce rates of patients excepted from Quality Outcomes Framework indicators.

In addition the provider should:

• Ensure that they are identifying carers so they can be signposted to appropriate support.
• They should ensure that they are keeping comprehensive records, particularly of meetings and discussions relating to safety incidents.
• They should ensure that they are using audits to make improvements to patient care.
• They should ensure that all consultation rooms have a privacy screen or curtain in place.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within 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 has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice