Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of St Werburgh's Medical Practice for the Homeless on 9 December 2015. The overall rating for the practice was Good. We carried out a desk based review on 19 September 2016 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 comprehensive inspection on 9 December 2015. At this inspection we identified further improvements were needed and therefore carried out a desk based review on 8 February 2017. The full comprehensive report on the 9 December 2016 inspection and the desk based review on 19 September 2016 can be found by selecting the ‘all reports’ link for St Werburgh's Medical Practice for the Homeless on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 8 February 2017 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 19 September 2016. This report covers our findings in relation to this requirement.

Overall the practice is rated as Good.

Our key findings were as follows:

• The provider had ensured the premises were safely maintained. Evidence of a satisfactory electrical wiring inspection and legionella risk assessment had been made available.

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 of this practice on 9th December 2015. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Werburgh's Medical Practice for the Homeless on our website at www.cqc.org.uk

Our key findings were as follows:

• Action had been taken to ensure the recruitment procedures were improved and the required information in respect of workers was obtained.

At the inspection on 9th December 2015 we also identified some improvements that should be made to the service. At the inspection on 19th September 2016 most of these improvements had been carried out. The security of the premises had been discussed with NHS England and there was a plan in place to promote patient and staff safety. The registered manager was now attending meetings on a regular basis and further audits for the service had been planned. A record was being kept of equipment checks and most of the required premises checks. It had been identified that the service responsible for undertaking premises checks was not able to provide an up to date legionella risk assessment or a electrical wiring safety inspection certificate.

There was an area of practice where the provider must make improvements:

• The provider must ensure the premises are safely maintained.

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 Werburgh's Medical Practice for the Homeless on 9th December 2015.

Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• There were appropriate systems in place to reduce risks to patient safety, for example, infection control procedures and the management of medication. However, the recruitment records needed improvement and improvements were needed to the records for building and equipment checks and the management of electronic prescriptions.
• Patients’ needs were assessed and care and treatment was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.

• A caring service was provided. Patients commented that they were treated with respect and dignity and that staff were supportive and helpful.

• Access to the service was monitored to ensure it met the needs of patients. Patients reported satisfaction with opening hours and said they were able to get an appointment when one was needed.

• The practice sought patient views about improvements that could be made to the service and acted on patient feedback.

• There were systems in place to monitor and improve quality and identify risk. However, the registered manager’s involvement with the practice should be more formalised in order to monitor the quality of the service provided. For example, by agreeing with the practice team bench marks to review performance and a formal plan for audits.

We saw that the practice was outstanding in the way it responded to the needs of its patients:

• The practice understood the needs of the patient population. It recognised that a high number of patients that were homeless experienced poor mental health and were alcohol and drug dependent. It also recognised that engaging patients to access primary medical and mental health services could be problematic. The services provided by the practice and in partnership with mental health services and other health services demonstrated the outstanding manner in which the practice had responded to these needs. For example:-

• The practice employed a counsellor and a bereavement counsellor was on secondment from a local hospice to respond to patients’ emotional and mental health needs.

• A mental health practitioner was available to provide advice to patients. They worked on a self-referral and open referral basis which meant that there was quicker access which encouraged patients to engage with this service.

• An optician service came to the practice to encourage patients to have their eyes examined. We were informed that this service had already enabled additional health needs to be identified in some patients.

• The nurse practitioner had organised health events were patients were provided with information and guidance about specific issues. For example, a men’s health day was held which included a presentation from the Fire Service about the Princes Trust.An event was also held for female patients with a focus on relaxation techniques, the importance of sleep and this included a presentation from local police about domestic violence.

• The nurse practitioner had been awarded the Queen’s Nurse Award in 2012 for services to the homeless.

• A flexible appointment system was in operation. Patients where provided with longer appointments as needed. Patients were seen on a drop in basis and patients who frequently missed appointments were never turned away when they presented at the practice. As patients may not visit the practice frequently reviews of long term conditions and vaccinations, such as, influenza vaccinations were carried out opportunistically.

• Staff spoken with were committed to the provision of a responsive service that was provided in a non-judgemental manner.

• Donations were sought to enable patients to be provided with toiletries and clothing when needed, for example, toiletries and pyjamas had been provided to patients going in to hospital. A Christmas sock appeal took place every year so that new socks could be provided to patients.

However there were areas of practice where the provider needs to make improvements:

• The provider must ensure that there is a record of the required recruitment information to confirm the suitability of staff employed.

There were areas where the provider should make improvements.

Importantly the provider should:

• Given the imminent reduction in security at the premises, undertake a risk assessment to ensure that staff and patient safety is promoted at all times.

• Ensure a record is kept of building and equipment checks, the outcome and when they are due to assist in monitoring the safety of the premises and equipment.

• Ensure a record is maintained of the numbers of the electronic prescriptions received and the printers they are distributed to in accordance with guidance from NHS Protect.

• Make the registered manager’s involvement with the practice more formalised in order to monitor the quality of the service provided more systematically.

• Put a plan in place for ensuring audit cycles are undertaken to demonstrate how patient care is assessed and improved upon.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about St Werburgh's Medical Practice for the Homeless on 25 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.