Letter from the Chief Inspector of General Practice

Seven Dials Medical Centre was previously inspected in October 2015 and was rated Good in all domains and overall.

At this inspection in November 2017 the practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

The practice is rated as requires improvement for providing safe, effective and well led services and this affects all six population groups:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students) – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We carried out an announced comprehensive inspection at Seven Dials Medical Centre on 21 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen, but these were not always comprehensive. When incidents did happen, the practice learned from them and improved their processes.

• Staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.

• The practice had systems in place to recall patients with chronic conditions for reviews and improve outcomes. However, these did not always translate into improved quality and outcomes as measured by the Qualities Outcome Framework (QOF).

• Care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those needing them were available on the same day.

• Appointments could be booked and repeat prescriptions ordered 24 hours a day via the new automated telephone option installed in response to patient feedback.

• The practice was equipped to treat patients and meet their needs.

• We observed the premises to be visibly clean and tidy.

• The practice worked with external stakeholders to improve patient services.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. By establishing more effective systems and processes to monitor, assess and improve patient care results from the Quality Outcome Framework.

• Ensure that care and treatment is provided in a safe way for service users, by implementing the correct procedures for Patient Specific Directions in line with regulations.

The areas where the provider should make improvements are:

• Carry out a risk assessment of the provision of medicines for use in a medical emergency that identifies and mitigates all potential risk.

• Assess whether to install a second independent back up thermometer into vaccine fridges.

• Review the recording of cleaning of clinical instruments.

• Continue to implement a more structured system of monitoring and recording of staff training.

• Consider formalising the vision values and strategy of the practice.

• Pursue the plans to include nursing staff in regular clinical meetings..

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 Seven Dials Medical Centre on 19 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing good, well-led, effective, caring and responsive services. It was also good for providing services for the six population groups.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 found it easy to make an appointment with a named GP and that 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.

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

Importantly the provider should;

• Review the records related to staff appraisals to ensure they include details of how staff are supported to develop and maintain their skills.
• Ensure records of significant events capture the actions taken to review changes to practice to ensure improvements are embedded.
• Review and amend complaint response letters to improve information for patients. For example, include the details of what action a complainant can take if they are unhappy with the response from the practice.
• Ensure the systems for obtaining feedback from patients are developed and maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with the practice manager, two GP’s (one of who was the registered manager), a practice nurse, a health care assistant and a receptionist to understand how the practice worked. We also spoke with eight patients (one of who was a member of the Patient Participation Group) to help us understand their experience.

We found that patients were involved in planning their treatment and care. A patient said, “I’ve had lots of health problems lately. The GP has explained things clearly and I’ve been there when they make referrals so I feel involved.”

Patients were treated with respect and their privacy was maintained. A patient told us, “I’m treated with respect and I’d soon complain if I wasn’t.”

Patients’ and other records showed that risks to their health and well-being were managed. Patients were referred to specialist health care professionals when needed. Patients could get urgent appointments and there were adequate facilities to manage medical emergencies.

A patient told us, “It’s very clean and hygienic, particularly the toilets which I think is important.” We found relevant government guidance in relation to infection control was being followed.

There were systems to ensure suitable staff were employed. Appropriate background checks were undertaken and GP’s and nurses’ professional registration was verified.

There was an annual patient survey carried out by the Patient Participation Group and there were arrangements for the practice to monitor standards of quality and safety.

A patient summed up their experience as, “It’s well organised, clean and gives you confidence.”