Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Great Sutton Medical Centre - Blue on 9 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for The Great Sutton Medical Centre - Blue on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 14 March 2017. Overall the practice is now rated as good with requires improvement for providing safe services

Our key findings were as follows:-

• There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, there were systems to protect patients from the risks associated with insufficient staffing levels and to control infection and keep the premises clean.

• 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.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt supported. They had access to training and development opportunities.

• Overall patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients.

• There was a system in place to manage complaints.

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

The areas of practice where the provider should make improvements are:

The provider should:

• Make a record of their periodic analysis of significant events and include further information in clinical meeting minutes showing how decisions in relation to these events were reached. Ensure that significant events are shared with all relevant staff and records show any events reported externally.

• Further training on the new electronic system (Intradoc) to record and share information about the operation of the practice should be provided to staff.

• The system for ensuring medication is reviewed when patients do not attend for an appointment should be improved.

• Ensure that a record is maintained of the reason why fridge temperatures are outside the recommended temperature range and the action taken.

• Ensure that emergency medication in glass containers is secure to guard against breakage.

• The systems for using alerts on records should be reviewed to cover patients at risk of self-harm and carers of relatives receiving palliative care.

• The salaried GP should have an in-house appraisal in addition to the external appraisal process.
• Encourage the uptake of carers on the practice register.
• Ensure that patient notes are updated following multi-disciplinary meetings.
• The practice should look at a representative from the nursing team attending their GP clinical meetings which would enable them to feedback to the regular nursing meetings that are now held.
• A survey should be undertaken to establish the current levels of patient satisfaction with access given the number of changes introduced. Surveys should be specific to patients from this practice.

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 The Great Sutton Medical Centre – Blue on 9th March 2016.

Overall the practice is rated as requires improvement.

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

• There were systems in place to protect patients from risks to their safety, for example, the systems around ensuring sufficient staffing and the management of medication. However we identified improvements that needed to be made to ensure the practice was operating safely.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice worked with other social and healthcare professionals to meet the needs of patients.

• Staff felt supported. They had received an annual appraisal and said they had access to the training they needed. The system for identifying the training needs of staff and ensuring that all staff undertook the training they required for their roles needed revision.

• Patients we spoke with and who returned comment cards were very positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients. The National GP Patient Survey January 2016 (data collected from January-March 2015 and July-September 2015) showed dissatisfaction with access, for example around getting through to the practice by telephone and access to appointments. Changes had been made to address these issues. Patients spoken with said that they were generally able to get an appointment when one was needed, in particular for urgent issues and that they were happy with the opening hours. Some responses from comment cards indicated continuing issues with access.

• There were systems in place to monitor and improve quality and identify risk. However improvements were needed. A record was not made of all staff meetings. Some policies and procedures needed revision. The work being undertaken to ensure all patients received the health checks they needed at the recommended frequencies needed to continue to demonstrate an improvement to patient outcomes.

• The practice sought feedback from staff and patients, which it acted on. There was an active patient participation group.

• The practice was aware of future challenges and had identified possible service improvements.

There were areas of practice where the provider must make improvements are:

• Ensure that there are systems in place for the management of significant events and that all staff are aware of the reporting process. Ensure there are clear processes for disseminating learning and actions following a significant event investigation and a clear system for review to ensure that actions identified have been and continue to be carried out.

• Ensure that there is a record of the required recruitment information to confirm the suitability of staff employed.

• Ensure there is an effective system for identifying the training needs of staff and ensuring that all staff undertake the training they require for their roles.

• Ensure there is a system in place to update all policies and procedures in line with current guidance and provide clear guidance to staff.

The areas where the provider should make improvements are:

• Ensure the system put in place for the safe management of prescriptions is maintained and all staff are aware of it.

• Carry out a review of the most recent infection control audit to identify that actions taken have been effective and to assess which actions remain outstanding. A timescale for addressing outstanding actions needs to be identified.

• Put a system in place to ensure all health and safety checks are carried out at the recommended frequencies.

• Nationally published data showed patient outcomes were lower for some long term conditions when compared to local and national averages. The systems for monitoring that patients were receiving the health care checks they needed at the recommended frequencies needs to continue to ensure that there is an improvement to patient outcomes.

• The system in place for monitoring verbal complaints should be reviewed.

• Review the arrangements for recording staff meetings and to the regularity of meetings amongst the administrative staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice