Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sunbury Health Centre Group Practice on 8 December 2015. The practice had been rated as good for caring and well-led, however, required improvement in safe, effective and responsive domains and therefore had an overall rating of Requires Improvement. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Improve processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
• Ensure systems are in place for disseminating information received from Medicines and Healthcare products Regulatory Agency to all appropriate staff members.
• Ensure Disclosure and Barring service (DBS) checks are in place for those staff members that acted as chaperones.
• Ensure that blank prescription forms are tracked and stored securely within the practice.
• Ensure that all staff have completed relevant training as required by the practice for basic life support, fire safety, infection control, information governance and safeguarding vulnerable adults and ensure evidence of this is recorded.
• Ensure that systems and processes are reviewed to complete referrals in a timely manner.
• Carry out regular fire drills.
• Ensure staff have regular appraisals.
• Ensure the complaints policy contains information regarding advocacy or the Ombudsman for patients to refer to.

We undertook this announced focused inspection on 14 July 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and are rated as Good under the safe, effective and responsive domains.

This report only covers our findings in relation to those requirements.

• There were robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses. Non-clinical staff also raised significant events and learning from all events was discussed with all team members.
• Information received from Medicines and Healthcare products Regulatory Agency was disseminated to all appropriate staff members and stored on the practices computer system.
• Disclosure and Barring Service (DBS) checks and training was in place for those staff members who acted as chaperones.
• There was a robust system in place for the tracking and secure storage of blank prescription forms within the practice.
• Staff had completed relevant training as required by the practice for basic life support, fire safety, infection control, information governance and safeguarding vulnerable adults and we saw training certificates to evidence this.
• A new referral system was in place which ensured that all referrals made by the GP were completed within four days. We checked the process and found that the practice no longer had a backlog and was working on referrals for the previous day and the day of the inspection only.
• The practice had carried out a fire drill, which had been discussed and evaluated with action points recorded. Six monthly fire drills were planned.
• A new appraisal form and system was in place for appraisals. Staff had received an appraisal, which recorded training requests, objectives and career development.
• The complaints information had been updated. It included information for patients in relation to advocacy and the ombudsman. Posters in the waiting area, leaflets and the website had also been updated with this information.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

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 Sunbury Health Centre Group Practice on 8 December 2015. Overall the practice is rated as requires improvement.

The practice was rated as requires improvement for providing safe, effective and responsive services. The concerns which led to these ratings apply to everyone using the practice, including all of the population groups.

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

• There was an open and transparent approach to safety. However, the system in place for reporting and recording significant events was not robust enough and there was no recorded evidence of lessons learnt or if this was shared with the wider staff group.
• Risks to patients were not always assessed or well managed. For example, Disclosure and Barring Service checks for staff working as chaperones, health and safety checks and completing regular fire drills.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they did not always find it easy to make an appointment. However, patients were able to see or speak with a GP in an emergency on the same day.
• The practice understood patient concerns in relation to the access of timely appointments and had increased appointments available each week following the appointment of additional clinical staff. However, the building the practice occupied did not allow them to increase the number of clinical rooms used and they were therefore currently unable to offer any more appointments with GPs or nurses due to lack of capacity. The practice was aware that the building was no longer suitable for the number of patients and had developed plans to address these issues but these were dependent on support and the adequate funding form NHS England
• The practice had good facilities and was equipped to treat patients.
• There was a clear leadership structure and staff felt supported by management.
• The practice had proactively sought feedback from patients and had an active patient participation group. Feedback from staff and patients was acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice had a number of policies and procedures to govern activity. The practice held regular meetings and issues were discussed at staff and clinical team meetings.

The areas where the provider must make improvements are:

• Improve processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
• Ensure systems are in place for disseminating information received from Medicines and Healthcare products Regulatory Agency to all appropriate staff members.
• Ensure recruitment arrangements include all necessary pre-employment checks for all staff and that DBS checks are in place for those staff members that act as chaperones.
• Ensure that blank prescription forms are tracked and stored securely within the practice.
• Ensure that all staff have completed relevant training as required by the practice for basic life support, fire safety, infection control, information governance and safeguarding vulnerable adults and ensure evidence of this is recorded.
• Ensure that systems and processes are reviewed to complete referrals in a timely manner.
• Carry out regular fire drills.
• Ensure staff have regular appraisals.

In addition the provider should:

• Continue to review patient access to non-urgent appointments.
• Take action to address identified concerns from staff members in relation to the effectiveness of the cleaning from the outside contractor (the cleaning company was not employed by the practice but by NHS Property Services).
• Ensure that provisions are made to safeguard patients where there is a delay in DBS checks being completed for new members of staff.
• Ensure there is a system for sharing appropriate information for patients with complex needs with the ambulance and out-of-hours services.
• Review and implement systems for assessing and monitoring health and safety risks including those assessments carried out by the building owner (NHS Property Services). For example, legionella assessments, health and safety and regular fire drills.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this inspection to look at the care and welfare provided to patients by the staff at Sunbury Health Centre. During our visit we spoke with three patients and seven members of staff, which included two GPs and the practice manager. We also collected six responses to a questionnaire we left in the waiting area.

Patients told us that staff always asked for consent before they provided any care or treatment. We found that staff were knowledgeable about consent and what to do if a patient lacked capacity to make decisions.

We found that patients received care and treatment that met their needs. Patients told us “The care is fine” and “I have no problem with the doctors.” However, most patients told us that the appointment system was not helpful.

Patients told us that they felt safe in the hands of staff at Sunbury Health Centre. When asked, we found that staff were aware of the safeguarding procedures within the practice.

We saw that staff had received regular training and appraisal and staff told us they felt supported by the practice.

We saw that the practice had a complaints procedure. When asked, two patients told us that they had made a complaint in the past and this had been dealt with satisfactorily.