We carried out an announced comprehensive inspection at Vine Medical Centre on 6 February 2019 as part of our inspection programme. We had previously inspected the practice in March 2017, where the practice was rated as Good.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was a clear leadership structure and staff felt supported by management.
• Staff worked well together as a team and all felt supported to carry out their roles. There was a strong team ethos and culture of working together for a common aim.

Whilst we found no breaches of regulations, the provider should:

• Review and continue to monitor cervical smear screening to meet Public Health England screening targets.
• Review the storage of patient notes.
• Review reception staff safety.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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 Vine Medical Centre on 15 December 2015. The practice was rated as required improvement overall. We completed a second comprehensive inspection on 13 June 2016 to ensure that the provider had improved. During this inspection the provider was still rated as requires improvement overall. During this inspection we found breaches of legal requirements. The provider continued to be rated as requires improvement for responsive services and the well led domain was rated as inadequate. The full comprehensive reports for both the 15 December 2015 and 13 June 2016 inspection can be found by selecting the ‘all reports’ link for Vine Medical Centre on our website at www.cqc.org.uk.

Following the 13 June 2016 inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that electrical appliances are safety checked on a regular basis.
• Ensuring that complaints are managed in line with the practice policy and that reviews of complaints are held with clear records of identified trends, lessons learned and actions taken as a result to improve patient experience.
• Ensuring there is a comprehensive system for the ratification, adoption and update of practice policies and that all staff are aware of this process.
• Ensuring that minutes of meetings are being appropriately recorded with clear decisions and action points

This inspection was an announced focused inspection carried out on 28 March 2017. This was to confirm that 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 13 June 2016. This focused inspection has determined that the provider is now meeting all requirements and is now rated as good under the responsive and well led domains. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• An external company had conducted an electrical installation condition report in August 2016.
• All portable appliances had been checked in June 2016 by an external company and we saw evidence of the report indicating that all equipment was safe to use.
• Patients could get information about how to complain in a format they could understand. The process for reviewing complaints clearly identified learning, trends or positive action taken to improve patient experience.
• Policies and procedures had been reviewed, clearly indicating their last review date and held relevant information for the practice. The practice manager held a spreadsheet of all policies and procedures which included dates for review. The practice manager also held this information on their computer calendar so that automatic reminders were in place.
• The practice held regular meetings including partner meetings, clinical and staff meetings. Minutes had a set agenda items and minutes included attendance. Minutes to meetings were sent to all staff so those who did not attend were kept aware of discussions had. Clear actions and key responsibilities were recorded in the minutes.

In addition we saw evidence of:

• The practice had installed a new phone system into the practice. This had increased the number of lines into the practice. The practice had plans in April 2017 to have a queuing waiting system added so that when patients called they would hear a recorded message of how many calls were in front of them.
• The practice originally had a virtual patient participation group (PPG) but had established a PPG which met face to face October 2016. The practice planned for the PPG to become involved in several aspects of the practice including discussing appointment availability, helping to update the practice website and ensure that current information is displayed in the waiting area.

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 Vine Medical Centre on 15 December 2015. The practice was rated as requires improvement in safe, effective, responsive and well-led. They were good in caring. We carried out a further announced comprehensive inspection on 13 June 2016. The practice is rated as inadequate in well-led, good in safe, effective and caring and requires improvement in responsive. They are rated as requires improvement overall.

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.
• Risks to patients were generally assessed and well managed. However, the practice had not carried out regular portable appliance safety checks or undertaken a risk assessment relating to this.
• The practice had made improvements in relation to infection control and medicines management processes since their previous inspection in December 2015.
• Data showed patient outcomes were comparable to the national average. There was evidence of audits being carried out and used to drive improvements to patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect. Patient feedback was positive in relation to people’s experience of care and national survey results reflected this in terms of patient’s involvement in their care planning and decisions.
• The practice had developed practice based services jointly with other providers such as diabetic and vascular clinics.
• A practice nurse had developed a respiratory support group for patients with respiratory conditions.
• The practice had procedures in place for managing complaints, however the review and subsequent learning from complaints was not sufficient.
• The practice had a number of policies and procedures to govern activity, but there was not a clear process in place for the ratification and adoption of policies within the practice. Some policies were overdue a review and others had been adopted from external sources without being localised to the needs of the practice.
• A lack of overarching governance framework within the practice had been identified during inspection in December 2015. This was found to still be the case in relation to policy management and the management of records relating to this and recording meeting minutes.

The areas where the provider must make improvements are:

• Ensure that electrical appliances are safety checked on a regular basis and that decisions as to the timeliness of checks are formed as part of an assessment of risk.
• Ensure that complaints are managed in line with the practice policy and that reviews of complaints are held with clear records of identified trends, lessons learned and actions taken as a result to improve patient experience.
• Ensure there is a comprehensive system for the ratification, adoption and update of practice policies and that all staff are aware of this process.
• Ensure that minutes of meetings are being appropriately recorded with clear decisions and action points.

In addition the provider should:

• Ensure that appropriate positive action is taken regarding patient concerns about getting through to the practice by phone.
• Ensure that the patient participation group is effective in improving services for patients.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

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 Vine Medical Centre on 15 December 2015. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were generally assessed and well managed. However, the practice had not undertaken a fire safety risk assessment.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had not always received training appropriate to their roles and further training needs had not always been identified and planned.
• Staff had not received regular supervision and appraisal of their performance.
• Clinical waste was not always managed in line with national waste regulations.
• Processes to monitor fridge temperatures were inconsistent and did not always ensure medicines were stored safely.
• The practice worked closely with other organisations and with local community services in planning how care was provided to ensure that they met patients’ needs.
• There was a lack of an overarching governance framework within the practice.
• There was a lack of systems in place for completing clinical audit cycles. The practice was unable to demonstrate that audits were driving improvement in performance to improve patient outcomes.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently and strongly positive. 

• Information about services and how to complain was available and easy to understand. However, the management of and learning from complaints was not always clearly documented.
• Patients told us they did not always find it easy to make an appointment with a named GP, although urgent appointments were available the same day.
• There was a clear leadership structure and staff felt supported by management.
• The practice sought feedback from staff and patients, which it acted on. However, the patient participation group required further engagement and development.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure clinical audits are used to promote continuous improvement and improve patient outcomes.
• Ensure a fire risk assessment of the practice premises is undertaken.
• Ensure staff undertake training to enable them to undertake their role, including training in the safeguarding of vulnerable adults, health and safety, fire safety, and information governance.
• Ensure all staff receive regular supervision and appraisal.
• Implement processes to support daily monitoring of fridge temperatures to ensure medicines are stored safely.
• Ensure effective processes are in place to ensure sharps bins and waste are managed in line with national waste regulations.
• Ensure the effective management, handling and recording of complaints.

The areas where the provider should make improvements are:

• Review patient access to the practice by telephone in response to GP patient survey outcomes.

• Undertake further review of staffing and allocation of duties in order to optimise and prioritise GP availability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice