Letter from the Chief Inspector of General Practice

We inspected this service on 2 December 2014 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

Our key findings were as follows:

• Patients were kept safe because there were arrangements in place for staff to report and learn from key safety risks. The practice had a system in place for reporting, recording and monitoring significant events over time.
• The appointment system was responsive to the needs of the patients. This ensured patients were able to access same day and emergency appointments.
• There were systems in place to keep patients safe from the risk and spread of infection.
• Evidence we reviewed demonstrated that patients were satisfied with how they were treated and that this was with compassion, dignity and respect. It also demonstrated that the GPs were good at listening to patients and gave them enough time.
• Staff were all clear about their own roles and responsibilities, and felt valued, well supported and knew who to go to in the practice with any concerns.

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

The provider should:

• Complete a risk assessment to identify a list of emergency medicines that the practice needs to stock.
• Provide staff who act as chaperones with appropriate training.
• Ensure all staff receive personal development and support.
• Record all discussions and actions to be taken from practice meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

This practice is rated as Good overall. (At the previous inspection on 2 December 2014 it was rated Good overall)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring?– Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Tunstall Primary Care on 22 June 2018 and returned on 26 June to review two staff records, that were not available on 22 June, 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. When incidents did happen, the practice learned from them and improved their processes. However, risk assessments were not always completed to mitigate safety risks to patients.
• Systems to assess staff immunity to potential healthcare acquired infections were not effective.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, patients prescribed the high-risk medicine, lithium, had not been monitored in line with national guidance.
• Reception staff had not received training in identification of the rapidly deteriorating patient.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system had improved and reported that they were able to access care when they needed it.
• There was a complaints system in place but information on how to complain was not readily available to patients within the practice.
• Staff stated they felt respected, supported and valued and there was an open culture within the practice.
• There were clear responsibilities and roles of accountability to support good governance and management. However, some policies did not reflect current guidance.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure specified information is available regarding each person employed.
• Ensure, where appropriate, persons employed are registered with the relevant professional body.

The areas where the provider should make improvements are:

• Update policies to ensure they reflect current guidance. For example, policies for safeguarding vulnerable adults, recruitment and maintenance of the cold chain when providing vaccinations in patients’ homes.
• Information regarding how to complain should be readily available for patients to access.
• Introduce a system for tracking prescription pads throughout the practice.
• Regularly monitor patients prescribed lithium in line with national guidance.
• Provide reception staff with training to identify the rapidly deteriorating patient.