Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Valence Medical Centre on 15 September 2016 and rated the practice requires improvement in all key questions that is safe, effective, caring, responsive and well-led. This led to an overall rating of requires improvement. The full comprehensive report on 15 September 2016 inspection can be found by selecting the ‘all reports’ link for Valence Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 June 2017 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 15 September 2016. This report covers our findings in relation to those requirements and also additional improvements since the last inspection.

Overall the practice is now rated as good.

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

• The practice now had a significant events policy and staff told us they would document any event which was unusual to the practice in the “event book” within 24 hours which was reviewed by the practice manager.

• We reviewed safety records, incident reports, patient safety alerts and minutes of meetings where significant events were discussed.

• The practice reviewed the system for identifying carers, for example, incorporating this information on the new patient registration form.

• The practice had fire risk assessments which were carried out by a qualified person in March 2017.

• There was now a legionella risk assessment in place for the branch surgery.

• The practice’s complaint policy was reviewed and updated in October 2016 to now include the current responsible person and a verbal log was now maintained.

• Performance for diabetes related indicators had improved based on 2016/17 data submitted to the Quality and Outcomes Framework (QOF). We also reviewed the practice’s process for exception reporting patients and found they followed national guidelines.

• At this inspection we found all medicines to be in date and the weekly and monthly log for medicines contained correct details such as expiration dates.

• There were processes for handling repeat prescriptions which included the review of high risk medicines.

• The practice had improved how it supported those with disabilities and had installed a hearing loop for those who had difficulty hearing.

• Improvements have been made to the overarching governance framework to support the delivery of individualised and quality care.

The areas where the provider should make improvements are:

• Embed processes to continually evaluate and improve the practice in respect of the processing of the information obtained from patient, for example, patient surveys.

• Review ways in which patients can access services, for example, the provision of a website.

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 Valence Medical Centre on 15 September 2016. Overall, the practice is rated as requires improvement.

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. However, there was no policy for staff to reflect on and we found significant events were not being recorded and therefore reviews and investigations were not thorough enough. Patients did not always receive an apology.
• Risks to patients were assessed and managed, with the exception of those relating to staff training, medicines management and emergency equipment.
• Data showed patient outcomes were mixed compared to the national average.
• Clinical audits had been carried and showed continuous improvement.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
• Patients said they could get appointments when they needed them but the waiting times to be seen were too long and it was difficult to access the practice by telephone.
• The practice had a number of policies and procedures to govern activity, but some were not practice specific and did not reflect current guidance.
• There was a clear leadership structure and staff felt supported by management.

The areas where the provider must make improvements are:

• Ensure effective systems and processes are adopted to report, record and investigate safety incidents thoroughly and ensure that patients affected receive reasonable support and a verbal and written apology.
• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure policies and guidance is practice specific with up to date information and are reflective of current legislations and national guidance.
• Ensure all staff receive and complete required training to carry out their roles effectively.
• Ensure that medicines and medical equipment are fit for purpose.

In addition the provider should:

• Review systems to identify carers in the practice to ensure they receive appropriate care and support.
• Put systems in place to improve and monitor patient satisfaction so that it is in line with national survey results.
• Ensure practice specific risk assessments are carried out by competent and experienced people and are reviewed regularly to manage risks, including fire safety, legionella and COOSH.

• Review complaints system to include recording and review of all complaints, verbal and written to improve services.
• Ensure systems are adopted to improve patient’s clinical outcomes including uptake of national screening programmes to be in line with local and national averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Importantly, the provider must:

• 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