This practice is rated as Good overall. The previous rating from 27 October 2017 was good overall with requires improvement in the responsive key question due to continued levels of poor patient satisfaction.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Park medical centre on

29 October 2018 as a follow-up inspection to ensure that the practice had made improvements in areas that were identified during the last inspection.

At this inspection we found:

• The practice had clear and comprehensive safeguarding systems and processes to ensure that patients were safe.
• The practice’s uptake of childhood immunisations was in line with local and national averages in areas. The practice was continuing to take action to improve those that had not met targets.
• Uptake rates of cancer screening were below local and national averages. The practice was aware of this and was taking action to address it.
• Quality improvement activity conducted by the practice was useful and accurate and had led to improvements in patient care.
• Patient satisfaction with the practice in terms of kindness, involvement and dignity were comparable with local and national averages. Some areas were 100%.
• A full range of patient feedback relating to access was considered by the practice, who had adjusted services to meet patient need. These had not yet been fully reflected in GP patient survey satisfaction results and access remained an issue for patients who we spoke with and from CQC comment cards. Unverified data provided by the practice indicated that some improvements to patient satisfaction had been made in terms of online access and access to local hub centres through the federation.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Consider ways to improve infection control practices relating to furnishing and recording.
• Continue to look for proactive ways to identify and support carers.
• Continue with efforts to improve immunisation and cancer screening uptake rates.
• Consider further ways to gather feedback to demonstrate improved patient outcomes and satisfaction.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We previously inspected The Park Medical Centre on 12 October 2016. As a result of our inspection visit the practice was rated as good overall, with a good rating for providing safe, effective, caring and well-led services. Although no regulatory breaches were identified during our last inspection, we identified areas where the provider should make improvements to appointment access and improving patient satisfaction. Therefore the practice was rated as requires improvement for providing responsive services.

We carried out a focussed desk based inspection of The Park Medical Centre on 27 October 2017. This desk based inspection was conducted to see if improvements had been made following the previous inspection in 2016. 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 The Park Medical Centre on our website at www.cqc.org.uk.

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

• We found that the practice had made some changes to improve access however, the information and evidence provided as part of our desk top inspection did not demonstrate improved patient satisfaction in relation to all areas of access.

• Responses to the practices 2017 internal patient survey highlighted that most respondents felt that access to appointments was very good or good however, there were some (40%) that felt that appointment access was poor or very poor.

• The information provided for our desk top inspection highlighted that the practice had increased the number of same day appointments to meet demand during busy periods, however the information provided did not demonstrate if this was helping to improve satisfaction rates.

• We saw that 61% of the responses to the practices 2017 internal patient survey indicated that telephone access was good, however 37% of the responses highlighted that this was poor. The practice provided further information following the desk top inspection which outlined actions taken to improve telephone access. However, the evidence provided did not demonstrate improved satisfaction.

• During our last inspection we looked at exception reporting for the Quality and Outcomes Framework (QOF) as part of our effective domain and we found that exception reporting was above average for mental health care. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects. Unverified data provided by the practice in October 2017, highlighted that exception rates had improved and mental health exception rates were now at 4%. This was an improvement from the 25% exception rate at the point of our last inspection.

• When we looked at the practices process for managing safety alerts as part of our safe domain during our last inspection, we found that the practice’s record keeping could be improved. A selection of meeting minutes were provided as part of our desk top inspection, these records showed that various alerts were received, disseminated and acted on in practice. We saw that record keeping was clear and demonstrated action taken in response to alerts.

There was an area of practice where the provider should make improvement:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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 Park Medical Centre on 12 October 2016. 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. All opportunities for learning from internal and external incidents were maximised.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs. 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.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from patients, which it acted on. The practice had patient participation group which supported practice development.
• The provider was aware of and complied with the requirements of the duty of candour.

• There was a strong team culture and the practice was cohesive and organised.

There were improvements the provider should make:

• The practice should record the actions that they have taken in response to safety alerts

• The practice should improve the process of clinical audit to continually improve patient care.

• The practice should continue to implement processes to monitor and improve the higher than average exception rates for QOF performance indicators

• The practice should take action to address the lower than average ratings in the national GP survey to improve access to the service

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice