Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Health Centre Practice on 5 December 2016. The overall rating for the practice was ‘good’, with ‘requires improvement’ for providing well led services. The full comprehensive report on the 5 December 2016 inspection can be found by selecting the ‘all reports’ link for The Health Centre Practice on our website at www.cqc.org.uk.

We undertook an announced focused inspection on 11July 2017 to check that the practice had followed their action plan and to confirm they now met legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 5 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• Patients with caring responsibilities were proactively identified so that appropriate support could be offered to them. After our previous inspection the provider had reviewed the numbers of carers and reiterated carers’ guidance and information via a carers information board and screen in the waiting room. A member of staff also had responsibility for providing information to carers and signposting them to organisations who were able to provide advice and support. The practice had 212 patients (1.8%) registered as carers, compared to 59 at the last inspection in December 2016.
• We reviewed the process for monitoring patients on high risk medicines and found that there was an effective procedure in place to ensure these patients received appropriate monitoring.
• At the December 2016 inspection we found that in the year prior only five out of 37 patients with a learning disability had attended for an annual health review. At our July 2017 inspection this number had remained low with seven out of 33 patients having undergone a health review in the past year. The practice advised us that a new nurse-led review procedure was due to be implemented imminently.
• There was a system in place to monitor progress with planned staff training to ensure that key training was kept up to date. The practice kept records of the registration and revalidation status of professional staff. The GPs and nurses were supported to address their professional development needs for revalidation.
• Blank prescriptions were kept secure at all times and tracked through the practice for their use.
• Any medicines incidents or ‘near misses’ were recorded and shared with the wider practice team to share any learning.
• There was an effective system for dealing with patient safety alerts, including alerts and updates from the Medicines and Healthcare Products Regulatory Agency.
• There were records to demonstrate the actions taken in response to infection control audits. However, the practice did not maintain effective cleaning schedules.
• Effective recruitment procedures were in place. The practice had successfully recruited a new clinician since our last inspection.

The areas where the provider should make improvement are:

• Review the systems used to complete annual health checks for patients with a learning disability.
• Maintain effective records that support the cleaning procedures in the 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 Health Centre Practice on 5 December 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording most significant events. However medicine incidents that occurred in the dispensary were discussed with staff but not routinely shared with the wider team and there was no record of learning or actions taken.
• Health and safety risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. 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 good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

The practice must have management oversight, and the systems and process to assess, monitor and mitigate risks relating to the health and safety of service users and others who may be at risk to;

• Ensure there is a system to monitor progress with planned staff training so that key training is kept up to date and to monitor the professional registration status of relevant staff.

• Ensure there is an accurate record of all completed recruitment checks

• Ensure there are records in place to demonstrate the actions taken in response to patient safety alerts, infection control audits and to demonstrate that cleaning schedules are completed.

• Ensure there is a system in place for tracking the use of prescriptions and for sharing incidents that occur in the dispensary with the wider team, recording the learning and actions taken.

The areas where the provider should make improvement are:

• Review systems used to proactively identify patients with caring responsibilities so that appropriate support can be offered to them.

• Review and strengthen systems used to monitor patients taking high risk medicines.

• Review the systems used to complete annual health checks for patients with a learning disability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice