This practice is rated as Good overall. (Previous rating 10 April 2018 – Good)

The well-led key question at this inspection is rated as: Good.

We carried out an announced focused inspection at The Village Medical Centre on 27 February 2019 to follow up a breach of regulation from our last inspection carried out on 10 April 2018.

The full comprehensive report on the April 2018 inspection can be found by selecting the ‘all reports’ link for The Village Medical Centre on our website at .

At the previous inspection of 10 April 2018, we rated the practice as ‘good’ overall but as ‘requires improvement’ in the well-led key question. We identified a breach of Regulation 17 HSCA (RA) Regulations 2014 - Good governance. This was because the provider did not have an up to date children’s safeguarding policy and they did not ensure that past medical records for patients were stored securely and protected against the risk of accidental loss, including corruption, damage or destruction.

This inspection was a follow up inspection to confirm that the provider had carried out their plan to meet the legal requirements. Our key findings were as follows:

• The provider had taken action to meet the breach of regulation.
• The children’s safeguarding policy had been updated.
• Past medical records were stored safely and the practice was about to embark on a project to have all patient records removed off site.

We also looked at action taken in response to the recommendations we had made to the provider following the last inspection visit. We found:

• The system in place for cascading patient safety alerts had been reviewed. Staff signatures were collected to show they had viewed the alert and records were made of any actions that were taken.
• The manager had reviewed the maintenance of the building and some repair work had been carried out. Consultation rooms, flooring in the patient waiting area and the patient toilet had been redecorated. However, the reception and patient waiting area still had walls that had large cracks and were in need of repair.
• The manager had reviewed the access restrictions for disabled patients at the entrance to the practice and a new disabled patient call system was now in place.
• A new virtual Patient Participation Group was set up to gain patient views about the services they received.
• Formal registers for patients who were vulnerable, at risk of safeguarding matters and those whose circumstances make them vulnerable such as patients with a learning disability were in place. These registers were up to date and reviewed regularly at practice meetings.
• Records were in place to show that all health care assistants were competent to undertake the extended duties they performed.
• The manager had implemented agendas for all staff minutes and completed robust minutes of each meeting.
• The manager had reviewed the practice's computer system to identify patients and family members who were carers, so that support services could be offered to carers and the people they cared for.

The areas where the provider should make improvements are:

• A risk assessment of the damaged walls throughout the practice should be undertaken.

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

Please refer to the evidence table for further information.

This practice is rated as Good overall. (Previous inspection October 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at The Village Medical Centre on 10 April 2018, this was a comprehensive inspection and we also followed up on the breaches of regulations identified in the previous inspection.

At this inspection we found:

• 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. However, the system for the dissemination of patient safety alerts required improvement.
• The practice had systems to safeguard children and vulnerable adults from abuse, however the safeguarding policy for children had not been updated.
• The practice had arrangements to ensure that facilities and equipment were safe and in good working order. However, there were a number of areas where maintenance improvements were required.
• The practice routinely reviewed the effectiveness and appropriateness of the care provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice did not have formal registers for patients who are vulnerable, at risk of safeguarding matters and those whose circumstances make them vulnerable such as patients with a learning disability.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• 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.
• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice did not have a Patient Participation Group (PPG) who could work closely with staff to monitor and develop services.

The areas where the provider must make improvements are:

• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

• Review the system in place for dissemination patient safety alerts to ensure records are made that alerts have been reviewed and acted upon by staff when required.
• Review the maintenance plans and arrangements at the practice and undertake repairs where building work has deteriorated. The provider should review the access restrictions for disabled patients at the entrance to the practice by completing a disability access audit.
• Review the efforts made by the practice to set up a Patient Participation Group and to obtain the views of patients about the services they receive.
• Consider the development of formal registers for patients who are vulnerable, at risk of safeguarding matters and those whose circumstances make them vulnerable such as patients with a learning disability.
• Review the human resource policies and procedures for staff recruitment.
• Review the records held to show that all health care assistants have been deemed competent to undertake the extended duties they are allowed to perform, such as administration of vaccinations.
• Review the agenda and minutes made for staff meetings.
• Review the practice's computer system so that GPs are alerted if a patient is a carer, so that support services could be offered to carers and the people they cared for.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of The Village Medical Centre. Our comprehensive inspection was a planned inspection, which took place on 2 October 2014. The practice provides services in keeping with its registration with the Care Quality Commission (CQC), as responsible for providing primary care, which includes: diagnostic and screening, maternity and midwifery services and treatment of disease, disorder or injury.

Patients told us that they were very satisfied with the services they received and spoke very highly about the health care clinicians treating them.

Visiting healthcare staff from local NHS community services, who were attending the practice on the day of the inspection, told us about how they highly regarded the standards of collaborative and integrated care provided by this practice and how the practice focussed on the provision of patient centred services across all the population groups.

The Village Medical Centre is a training practice for fourth year medical students.

We have rated this service overall as good.

There was good access to appointments, patients were supported by a listening and responsive service

Our key findings were as follows: The service was patient centred seeking to provide safe and improving services in clean facilities, using effective systems and evidenced best practice and respecting people’s privacy and dignity

We saw several areas of outstanding practice including:

The practice provided examples illustrating how the practice took time to send a practice nurse out to patients at home to monitor and support them and communicated their actions well to relatives of older people who lived far away from their family. Also, the practice made daily use of map of medicine healthguides. These care maps are made up of a series of steps. These include tests, treatments, referral to specialists, and links to other care maps. Their use supports best practice and they encourage joint decision making between doctor and patient.

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

Importantly, the provider must:-

Ensure that patients are protected by gathering and reviewing the information in relation to people working at the practice as required by the regulations of the Health and Social Care Act 2008. This concerns the recruitment of staff and the personnel information required including proof of identity, qualifications, employment history and relevant Disclosure and Barring Checks (DBS) are carried out, if necessary to the role, and the relevant information retained as required by the legislation.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice