This practice is rated as Good overall. (Previous rating June 2015 – Good)

The key questions at this inspection 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

We carried out an announced comprehensive inspection at Swanlow Medical Centre on 20 November 2018 as part of our inspection programme.

At this inspection we found:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• There were shortfalls in the required information to demonstrate staff were suitable for employment. The practice was not able to show all clinical staff had completed fire safety and infection control training.
• 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.
• The most recent results from the GP national patient survey (August 2018) showed patient satisfaction with the service. Feedback was overall in line with local and national averages.
• The practice monitored patient access to services. It had a range of appointment options available for patients which included extended hours.
• The practice organised and delivered services to meet the needs of patients.
• There was a system in place for investigating and responding to patient feedback including complaints.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• The practice engaged with local community organisations and charities to support patients.

We saw one area of outstanding practice:

• One of the GPs had worked closely with the local hospital and had just completed a 12-month pilot in a community heart failure clinic. They had worked to expand this to one clinic for each care community across the locality. This had significant benefits for the heart failure patients at this practice who could be treated locally, in a timely manner, adhering to the latest NICE quality standards for chronic heart failure. This also supported other clinicians to develop their cardiology skills to deliver improved care for all patients.

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

• Ensure specified information is available regarding each person employed.
• Demonstrate that all staff have received training in fire safety and infection control suitable for their role.

The areas where the provider should make improvements are:

• Review the safeguarding procedures to provide guidance for staff on female genital mutilation (FGM), modern slavery and Prevent.
• Document the safety measures in place to promote the safe storage and use of oxygen and the measures in place to promote the security of the premises.
• Complete cleaning schedules for rooms and equipment and record observations of the cleaning standards provided by the external cleaning company.
• A copy of the annual review of complaints should be kept at the practice to show that complaints are reviewed to identify patterns and trends.
• Formalise the system for reviewing the practise of clinical staff to ensure consultations, referrals and prescribing are appropriate.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swanlow Medical Centre. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring, safe and responsive services. It was also good for providing services to meet the needs of all population groups of patients.

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

• There were systems in place to protect patients from avoidable harm and abuse. Staff were aware of procedures for safeguarding patients from risk of abuse. There were appropriate systems in place to protect patients from the risks associated with medicines. The staffing numbers and skill mix were reviewed to ensure that patients were safe and their care and treatment needs were met. We found improvements should be made to the records for staff recruitment and the systems for sharing information from safety incidents.

• Patients care needs were assessed and care and treatment was being considered in line with best practice national guidelines. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed. We found improvements should be made to the records of staff training.

• Feedback from patients showed they were overall happy with the care given by all staff. They felt listened to, treated with dignity and respect and involved in decision making around their care and treatment.

• The practice planned its services to meet the differing needs of patients. The practice encouraged patients to give their views about the services offered and made changes as a consequence.

• Quality and performance were monitored, risks were identified and managed. The practice ensured that staff had access to learning and improvement opportunities.

There were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Review the systems for sharing information from safety incidents to ensure learning points are clearly and effectively shared with all relevant staff.

• Demonstrate that they have obtained satisfactory information about any physical or mental health conditions which are relevant to the duties to be performed by staff. Make a record of on-going checks carried out of the professional registration of GPs.

• Ensure evidence of competence of staff to perform their duties is available at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an inspection at Swanlow Medical Centre on 20 November 2018 as part of our inspection programme. The overall rating for the practice was Good, however we rated the practice as Requires Improvement for safe. The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Swanlow Medical Centre on our website at .

This inspection was a desk-based review carried out on 14 February 2019 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 20 November 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

• The system for recruiting staff had been reviewed to ensure only fit and proper persons were employed.
• The provider was able to demonstrate that all staff had received training in fire safety and infection control suitable for their role. 

The provider had taken action to address the areas where we advised them that improvements should be made:

• The practice was monitoring the training needs of staff with particular regard to safeguarding children and adults and infection control. A designated member of staff was monitoring and taking appropriate action to ensure staff had appropriate time and resources to complete required training.
• Appropriate signage was in place to direct the Fire Brigade to the storage of the oxygen. 
• The practice had developed clear areas of responsibility with the other practice in the building with regard to the roles and responsibilities of Fire Marshalls.
• The practice had introduced monthly cleaning spot checks on a sample of clinical rooms and communal areas to support their infection control systems and processes.
• The practice held a copy of the annual review of complaints that supported the identification of trends and patterns.
• The practice had introduced a formal system for reviewing the practise of clinical staff to ensure consultations, referrals and prescribing were appropriate.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice